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Wednesday, January 27, 2010

Has The Time Come To Just Ignore NEHTA and Get on With It?

In the last few weeks I have been wondering just where NEHTA, as a company limited by Guarantee, really fits into the picture.

As far as I can tell there is no Government Act or regulation which enables NEHTA activity in the sense that other regulators – for example the Therapeutic Good Administration (TGA) – undertakes.

A search for NEHTA at the Australasian Legal Information Institute - A joint facility of UTS and UNSW Faculties of Law reveals no legislation at all.

The only mentions found in the zillions of databases refer to Australian Law Reform Commission reports on privacy and the like.

See http://www.austlii.edu.au/

On the other hand a search for the TGA immediately finds the Therapeutic Good Act (1989) and all the associated material.

See here:

http://www.austlii.edu.au/au/legis/cth/consol_act/tga1989191/

There are hundreds of citations and cases where the TGA has used it powers to enforce its decisions.

We also know that NEHTA needed to work with the Commonwealth Health Department of Health to get the Draft Legislation for the HI Service going – tells me they have no powers in that regard either.

Additionally, I am told that internally within NEHTA it is well recognised that while NEHTA has funding via the COAG process its actual regulatory and enforcement powers, when push comes to shove, are non-existent except in the commercial domain where they could influence some jurisdictional purchasing decisions.

I will note that as we saw with the recent SA Health Tender it is not clear just what even influence they had in framing and specifying what was needed.

See here:

http://aushealthit.blogspot.com/2010/01/south-australian-health-treats-nehta-as.html

My feeling is that while it may be pragmatic to ‘play ball’ with them whenever possible, where there are commercial or reputational issues at stake taking some advice on just exactly where one stands and discovering what is bluster and what is real authority, may be pretty smart. I suspect they are a ‘paper tiger’!

Well considered and relevant projects should not be blocked or slowed down just because of an almost certainly impotent regulatory fiat! The time has come for NEHTA to transform into something that is of value to the e-Health task in Australia or just get out of the way.

David.

15 comments:

Anonymous said...

David, I can't believe it's taken you so long to figure this out.

NEHTA was set up to own all of the risk and exposure for the e-health agenda, but was denied any powers to actually implement it. Making it a pty ltd company which couldn't be FOI'ed was a masterstroke - AHMAC must still be chuckling about that. Thanks BCG, money well spent.

It is extremely convenient for government to have the peanut gallery hurling themselves at NEHTA, leaving the real powerbrokers in health with clean hands and effortless influence across the agenda.

And of course DoHA had to draft the HI legislation, since NEHTA is not part of government, and hence has no powers to create it.

Peter West said...

Where does this idea that NEHTA is not subject to FOI come from?

I have an email from Jim Claremont, Department of the Prime Minister and Cabinet to the effect that NEHTA has been identified as an agency for the purposes of the Freedom of Information Act 1982 (Cth).

FOI requests for NEHTA documents can be lodged with
Department of Health and Ageing
GPO Box 9848
CANBERRA ACT 2601
FOI Contact Officer is on 02 6289 1718.

Go for it!

Anonymous said...

OK, this is positive. Perhaps we can suggest Nehta support the "Fade to Black" campaign and keep up the protest indefinitley??

Perhaps the local state governments complete lack of standards compliance is also the reason why Nehta chooses to ignore them. The answer of course is simple, ignore Nehta and get on with it.

Anonymous said...

I find this interchange confusing. The states are funding NEHTA. DOHA is funding NEHTA. So surely it would be suicidal for NEHTA to ignore the states!

Also, nearly all the professional medical bodies including the AMA and RACGP promote NEHTA through involvement with the ‘Clinical Leads’ led by a GP and Past President of the AMA. So unless something changes NEHTA and the peak medical bodies have become, and will remain, inter-dependent on each other in a way where neither can ignore the other even if they wanted to; regardless of which blind person is leading the other.

Finally, some vendors might mumble away under their breath, but which vendors have been openly critical of NEHTA’s approach? Any? And what of the MSIA which claims to represent software vendors. How do they view the relevance and applicability of NEHTA and its work? Silently?

So when you say “The time has come to just ignore NEHTA and get on with it” I can’t help but wonder ‘How’? How can any of those mentioned above ‘get on with it’ when the funding and political linkages are so intertwined and knotted up with each other as to render each relatively impotent to effecting change.

Dr David More MB, PhD, FACHI said...

I agree there are lots of linkages - but after 5 years we are no further ahead and so it is time, I believe, for a whole different approach. It might be that a more market driven approach with Government just getting out of the way and stopping pretending it actually knows anything or can do anything. Remember we have had over a decade of this and most of the progress has been private sector rather than public sector driven.

I recognise this is complex, but what we are doing at present show no signs of working after what I reckon is a reasonable time.

David.

Anonymous said...

Thursday, January 28, 2010 9:16:00 AM asked "how can any of those mentioned above ‘get on with it’ when the funding and political linkages are so intertwined and knotted up with each other as to render each relatively impotent to effecting change". The answer is either - they can't, they're stymied, they have to live with the impasse or they have to demand changes are made. The latter is easier said than done because unless they have some precise answers they can demand nothing. Either way it looks as though they really are stymied.

Anonymous said...

A whole different approach rolls easily off the tongue but as you say "this is complex". New thinking is not easy in the face of resistance to change and new thinking will never emanate from the old hands because they are unable to think differently. So who are the new thinkers and where do we find them?

Dr David More MB, PhD, FACHI said...

My view is that there was some excellent 'new thinking' in the Deloittes Strategy and that, this is a sensible way forward - given some quality leadership and political will. That overall approach has a chance of getting somewhere - but most of the pre-conditions are not in place and until they are (funds, leadership and agreed sensible plan) we should stop spending in dribs and drabs on things that will probably fail.

David.

Anonymous said...

The private sector will unilaterally move where there is a clear commercial incentive to do so - consider the contemporary example with the various ePharmacy implementations. Without some clear commercial advantage to them or their clients they would have been stupid to proceed.
The states are tied to individual projects and are having enough trouble getting project successes on the board without adding to project cost and risk by adhering to some NEHTA specification that has no standing as an Australian standard and no clear indication of widespread support - how many times has NEHTA got pathology wrong?
So unless NEHTA shows firstly that it can produce some clinical eHealth specifications that have widespread support and secondly shows sufficient leadership to champion a particular project through to completion and finally to provide sufficient logistical and financial support to implementers, then nothing is going to happen. In short NEHTA has never shown us that it has a realistic plan for implementing anything, including the current UHI fiasco.

Lamenting "this is complex" is the great cop-out and treacherously allows the current do-nothing scenario to seem justifiable. It also neglects the fact that there are some things that aren't so difficult.
There must be a first step in any complex journey. Time and time again, NEHTA and its HealthConnect and Mediconnect predecessors have shown that they are unable to take a credible first step, let alone navigate a clinical project thru to completion. NEHTA has never once stated where it intends for us to go.

NEHTA is irrelevant. Sadly, the corollary to that theorem is that national eHealth in Australia is dead.

Dr David More MB, PhD, FACHI said...

That final sentence is certainly something those who have watch this for years have pretty much reached.

David.

Anonymous said...

Unfortunately , "this is complex" is true, and is the one of the reasons that the health/medical industry has not made the significant advances in electronic information transfers that other, perhaps more ordered, industries have.

This is compounded in Australia by a tendancy to regard the e-health imasse as a technical or engineering problem awaiting a magic bullet solution from NEHTA or for a legislative blueprint from Government before we can move forward. This is a vain hope, because e-health is part of the complex human system that delivers health care, and it has proved thus far, to not be amenable to simple technical solutions.

Far better for the Government to adopt a simpler tack and approach e-health as a Complex Adaptive System and focus on promoting ethe volution and adaption of e-health systems to address local issues, rather than attempting to effect an enforced outcome (probably blinkered by past experience or vested interests) via bureaucracy, and monolithic rules and regulation.

At its most basic this means:
creating the starting conditions for the evolution of e-health systems,
providing simple rules and boundries for participants,
and by articulating a vision that encourages creativity at the local level.

A few dollops of money to stimulate (not underwrite) desirable activity would not go astray.

This approah is neatly summed up in Dave Snowden's Children's Party story http://www.youtube.com/watch?v=Miwb92eZaJg

As previously noted the long standing success of electronic diagnostice result delivery is a good example of people seeing a problem, devising a solution, and delivering it (e-prescrbing is a more recent example)

This is all perhaps to much to expect from NEHTA or DOHA, so in all probability it will have to be the e-health practitioners and vendors who will have to take the risks, maybe loose some skin, and jsts get on with doing it ( and hope to perhaps reap some of the benefits of being first movers).

Anonymous said...

"NEHTA is irrelevant. Sadly, the corollary to that theorem is that national eHealth in Australia is dead."

While I don't yet necessarily agree with the proposition, the corollary may actually be the opposite. After all, when in the history of Australian e-health has government done anything but slow innovation by distracting software vendors and making providers jump backwards through hoops.

Anonymous said...

It is too difficult to simply ignore or even dismantle NEHTA. There is too much political capital tied up in it to do that. Even so to permit NEHTA to continue under its current governance (or lack thereof) and in its present form under its current organisational structure and leadership will, without doubt, cause the Rudd Government enormous political pain at the next election.

Kevin Rudd has placed health firmly near the top, if not at the top, of the political agenda. He has told the states what they can expect if they don't shape up. In the midst of this forthcoming bunfight health ICT (ehealth of you like) will be a significant political football tied in with the hoary old arguments that a PHR(EHR) will fix all the problems. We all know that is simply not true.

The best option for Kevin Rudd and Nicola Roxon is to cut their losses ASAP and distance themselves from NEHTA as far and as fast as possible. That will be a very difficult exercise.

Anonymous said...

If Kevin Rudd, Nicola Roxon and their advisors are ignorant of the appalling situation re NEHTA it will be impossible for them to comprehend that in the interest of preserving political capital the "best option for Kevin Rudd and Nicola Roxon is to cut their losses ASAP and distance themselves from NEHTA as far and as fast as possible. That will be a very difficult exercise."

Anonymous said...

Never was a truer word writ - (Thursday, January 28, 2010 10:20:00 PM) “this is all perhaps to much to expect from NEHTA or DOHA, so in all probability it will have to be the e-health practitioners and vendors who will have to take the risks, maybe loose some skin, and just get on with doing it (and hope to perhaps reap some of the benefits of being first movers). A good example is electronic scripts - viva la Pharmacy Guild for making the investment and taking the risk. Other examples are harder to identify.