Last week the blog revealed that in March, 2009 there had been serious doubts about just how well the project to provide Health Identifiers was going.
This blog can be read here:
http://aushealthit.blogspot.com/2010/02/nehta-is-leaking-like-sieve-symptom.html
The key paragraph is here (from the Executive Summary):
“Review Approach
This report details the results of a project health check undertaken of the Unique Health Identifier (UHI) project at nehta. The project review was undertaken over 10 days and involved in-depth interviews of project team members, suppliers and senior managers and a review of key project artefacts. The report assesses the UHI project’s health in 14 key elements, notes any exceptions to these findings and makes recommendations for improving the health of the project. Annex A outlines the approach to interviews and questionnaires used in the review.
Using the intelligence gathered through the project health check (scored in Annex B), an assessment has been made of the project’s ability to deliver. Overall, the Unique Health Identifier project is rated as RED. Unless significant changes are implemented, this project will not deliver agreed scope within timeline or quality tolerances. There are critical issues and concerns that exist within the project that require management intervention by the project sponsor, programme management and other senior management.”
---- end quote
The one line summary is that the project is a major mess and that without major intervention the whole thing has a high likelihood of failure.
The review project took 10 days and so, and – having reported on March 13, 2009 – was probably actually undertaken in mid to late February. Even if not written up what had been found would certainly have been made clear, in broad terms, to NEHTA senior management at that time.
Consider now this post.
http://aushealthit.blogspot.com/2009/03/senate-estimates-questions-on-e-health.html
This blog reported on the proceedings of a Senate Estimates hearing.
STANDING COMMITTEE ON COMMUNITY AFFAIRS ESTIMATES
(Additional Estimates)
WEDNESDAY, 25 FEBRUARY 2009
CANBERRA
BY AUTHORITY OF THE SENATE
2 key items in the transcript is the following exchange:
----- Begin Quote
Blogger Comment at the time: Next there was this explanation of the NEHTA work program.
“Ms Morris—Sorry, Senator, I am just getting the list. It is a long attachment because there is a lot of good stuff in here, as Ms Halton said. What I will run through is what they have got in their current 2008-09 work program, which is delivering a lot of really useful outcomes and, as Ms Halton said, getting to the stage where people are hopefully understanding and seeing how it all will build up to a picture of an individual electronic health record. Development of e-health capabilities: I always have to try and translate this into English. Within that, they have things called domain packages, which can be broken down into discharge summaries. For instance, when a patient is discharged from hospital, an electronic summary of what happened to them in hospital, what medications they are on, what procedures were undertaken, what diagnostic imaging, whatever—“
Blogger Comment at the time: This really does not inspire much confidence. Does anyone think that discussion betrayed a deep understanding of what NEHTA is doing and why?
Then there was discussion of the IHI as discussed previously in the blog. It was here we learnt:
“Senator BOYCE—So by the end of the year we should have the unique identifier?
Ms Halton—Yes, we should.
Ms Morris—Yes.”
Blogger Comment at the time: I think somehow the pilot idea somehow slipped through the cracks! The timeframe looks a trifle adventurous also – but we shall see!
This was then followed by this:
“Ms Halton—Yes, that is right. The other thing that is going to be delivered by the end of the year is secure messaging. In other words, not only do you want to know who it is you are talking about but also you want to be able to say quite confidently to patients that the information that goes via this mechanism to this other party is not going to disappear into cyberspace and cannot be in some way tampered with or siphoned off by somebody else. It has to be secure. We all think that privacy in respect of health is incredibly important, and so secure messaging—which again is in this timetable—is one of these key things to be delivered.
So when I talked at the beginning about this then enabling patients to start to see these things actually happening, you need all of these things before you can start moving your pathology results around electronically. Before enabling you to manage the medications electronically, you need to know what the medications are, you need to be able to code them consistently, you need to know it is you who is taking them and not Senator Moore or whoever else, and you need to know who has prescribed what and if it has been dispensed. Does that make sense?
Senator BOYCE—Yes.
Ms Halton—With these what we call ‘foundation parts’ of e-health, COAG agreed that we would continue with this investment to keep building on each of these elements that are all moving towards an integrated, electronic health record. Part of the work is a little nebulous. When you say that one of the things we are working on is engagement or policy or privacy or whatever else, we still need to fund those things, because we need to able to assure consumers that their privacy will be protected. We also need to ensure that we manage change with the professions.”
Blogger Comment at the time: Ms Halton does not seem to be at all clear that to move from the foundations to an actual EHR or whatever form is big and probably not cheap. To her that is ‘nebulous’. A bit of a worry!
Note privacy is important – but no plan to manage it is mentioned. Need to keep it simple I guess. If there was legislation being prepared I am sure it would have been mentioned.
----- End Extract from Old Blog.
At the time these two senior bureaucrats were briefing the Senate – presumably under oath – we now know that NEHTA was sufficiently worried about the HI Service project to get a paid review and almost certainly had a good idea of what the review would say. Somehow this news just did not seem to make it to those fronting Senate Estimates – who were happy to state, for the record, it was all wonderful and December was looking good for identifiers.
We now know that both messaging and identifiers were not delivered in December (whatever delivery actually means) and still haven’t as far as one can tell.
Seems to me all this shows, at best, is an unacceptable lack of curiosity to actually find out what was going on, knowing there would be specific e-Health questions at Senate Estimates, and at worst a blatant misleading of the Senate.
However you look at it there is no reason I can see to ever believe anything we are told again! Do you?
David.
Addendum:
It is worth noting the issue of failure of communication between NEHTA and DoHA has been around for a while. See here:
http://aushealthit.blogspot.com/2009/03/nehta-ceo-disagrees-with-secretary-of.html
Really this lot would struggle to lie straight in bed!
D.
4 comments:
No one wants to face the facts. Everyone wants to duck for cover. It seriously looks as though one humongous confidence trick has been played out the last few years and, as is usually the case, the point has been reached where the perpetrators have been caught out with nowhere to turn. That time has surely come.
With the potential for an election later this years the decision on Nehtas fate is likely to become political.
Given that Medicare is actually doing the IHI work and Nehta have not shown any ability to manage the process or grasp the complexities of the eHealth world then the smart political decision would be to let the axe fall soon and let Medicare continue on, with an excuse for a delay.
Letting this mess fester until close to an election is a recipe for disaster. It appears that the states are "responsible" for Nehta anyway and it could be viewed as just another failure of state health management rather than a federal responsability. It would line up well with there general management skills when it comes to hospitals.
The obvious problem is what to do then... I think a US style program with specification of Standards and a compliance agenda rather than the "We will come up with the specifications" plan would be a healthy idea. There may then be some money available to actually reward organizations that can actually implement standards!
The shadow of the chopping block must be hard to ignore at the moment.
I doubt NEHTA will see the chopping block getting closer every day until it removes its blindfold. Take it from me - the rash of job advertiesments on NEHTAs webs site does not reflect expansion - it's to fill the vacancies left by those who know tis better to jump ship early before she goes down to Davey Jones Locker. Peter Flemming might get some fresh ideas from Pirates of the Carribean. Johnny Depp where are you?
The unfortunate point around this lack of accountability is that it is really endemic to the whole Australian health system, not just DOHA and NEHTA. They are to some extent reflecting a deeper malaise.
Is the AMA held accountable for the challenges in the professional workforce? Is NSW Health held accountable for the dire state of NSW hospitals? Is the RACGP held accountable for the dire state of primary chronic care? Sure, we can argue who is truly responsible for any of these issues, but we've managed to diffuse accountability in much the same way as we diffuse responsibility.
NEHTA should be accountable for the state of eHealth in Australia. They are not responsible for all aspects and must work with broader stakeholders to achieve success, but the must be held accountable.
GP's are not truly responsible for the poor state of chronic care in our community, really the poor experience of patients with chronic conditions is a symptom of the disjointed organisation and misaligned incentives of primary care, but an organisation like the RACGP should be held to some account for this.
Is NSW Health responsible for the poor state of NSW Hospitals? Arguably there are many factors such as inadequate budget, workforce changes, etc but ultimately they must be held accountable.
My point is responsiblity and accountability are not equivalent, and the bureaucrats of DOHA, NEHTA and many others too often suggest that they are equivalent.
NEHTA says it's not able to deploy the systems to the last mile - that that job is for system vendors, therefore they're not responsible for the state of eHealth. I agree, they're not responsible. But, we should hold them accountable. And they have been shamefully unaccountable to date.
I think two recent websites are interesting examples in the kind of transparency that can ultimately lead to accountability. The mySchools website launched last week in Australia and within a day, questions were being asked by parents about why the school their child was attending had fared so poorly.
Only a few weeks ago, the NHS in the UK significantly expanded the NHS Choices website with a similar table for assessing primary, dental and hospital providers.
Have a look at:
http://www.nhs.uk/ServiceDirectories/Pages/ServiceSearch.aspx?ServiceType=Hospital&InputError=Default
Somehow, I find it hard to imagine a similar service in Australia. Why is that? My gut instinct is that in Australia we seem to find it very difficult to hold any organisation accountable for their performance, unless they are totally responsible and able to control that performance. In health, everyone's responsible? So is no one accountable??
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