Dr Andrew McIntyre let me know (via Skype) he had posted this blog on the Medical Objects Web site about 12:20am this morning. Needless to say I was asleep at the time and picked up the instant message when I came down to the office this morning.
This is very serious stuff indeed I believe.
Over to Andrew.
NEHTA – On the road to nowhere?
National Health IT programs do not have a good record of success in general, and Australia has been a good example of that to date. I don’t think anything is about to change.
The reasons for this will no doubt be well understood in time, as history looks back and shakes its head in dismay at the wasted resources and opportunities. It’s hard to pinpoint the reasons for failure until you have success to contrast it with. I think a large part of the problem is the top down approach to a problem that can only be solved bottom up. By many measures Australia has been a leader in eHealth to date, but I don’t think any of that can be attributed to government policy or support as its mostly been bottom up. Certainly the National eHealth Programs of the past have failed to progress the situation and have in many ways just distorted the market for the worse.
While some will say the issue is “Change Management”, I think this is wrong. To have change management you need to have a change worth implementing and to date the quality has not been there to justify change. The quality needs to be in the software and eHealth is a complex beast to tame. To progress it we need to have the foundations to build on and currently they are sitting on swamp. Netha appears determined to adopt the tunnel vision of its “Stakeholders” i.e. The state health departments and ignore the bigger picture of the international markets and standards bodies. Despite ample evidence that the existing infrastructure is cobbled together and working in the most fragile manner conceivable they want to march on and implement national programs without any compliance agenda on the horizon for at least 2 years. Building anything on the current infrastructure without a resolute compliance program is a recipe for disaster.
Australia currently has good penetration of HL7 V2 messaging, but the quality is patchy and the interoperability extremely fragile. Any change to messages results in failures and in effect we are locked into a situation where only a few systems can handle compliant data. This is interconnectivity and is a long way from interoperability, it’s a road to nowhere and in reality the known errors in existing lab messages cannot be corrected because of the fear of breaking existing systems. Despite Australia having compliance testing available there appears to be a complete lack of understanding of its importance by Nehta. Rather than underpin the cracking foundations before trying to renovate the building Nehta is determined to add another 3 stories to the building. The earthquake in Haiti demonstrated the dangers of a city built without adequate building regulation. Nehta’s plans will result in major loss of life at the first sign of a tremor, even if they manage to build something (which they have failed to do to date).
Interconnectivity without interoperability is a recipe for disaster and this appears to be the agenda. Delivery at all costs appears to be the political motivation and I think it’s time to reject the short term political goals and try and attack basic compliance and quality now. The software term “Design by Contract” was never meant to mean a business contract, but a compliance contract. Nehta appears not to get this and wants to substitute “contracts to deliver a business plan” for “contracts to comply with standards”. Computers are quite bad at being politically correct and will reject business plans that lack credibility at the binary level.
The real issue in eHealth is a lack of quality, and subsequently a lack of interoperability and safety. There are fundamental engineering deficiencies in the real world and a lack of realization that only standards, and good compliance with standards can fix the flawed foundations. Foundations are not sexy, but getting the structure out of the ground is always the biggest hurdle on a building project. To improve the situation we need a focus on good software engineering practices and in the world of complex systems that means testing and more testing. The reality is that HL7 V2 is going to be around for many years to come and rather that march on with grand plans the priority needs to be getting a compliance program for existing standards up and running now. Moving to something new is an expensive diversion that will make the problem worse, not better. Someone needs to stand up and stop claiming they will deliver the 10 story masterpiece “next year” and start work on a compliance program for what is already in use. We need some solid foundations or the Haiti style devastation of eHealth will surely descend upon us within a few years.
The Nehta plan, as it stands will deliver fragile single purpose interconnectivity with little or no interoperability. It’s time we turned our existing interconnectivity into interoperability by a deliberate compliance agenda. Once that’s done we will be out of the ground and ready to do some real work. As it stands they are on a road to nowhere. We have been down that road and we know where it leads.
The original full posting is found here:
For those who don’t know here are a few words about Medical Objects:
Medical-Objects is an eHeath company dedicated to standards based EHR applications and messaging. Born out of frustration with the lack of progress we are working hard to get the standards and infrastructure in place to make the care of patients easier and more efficient. Our focus is clinical medicine and decision support and any missing infrastructure needed to implement this. While we are best known for our secure messaging, this is just (an important) building block that we need to enable our vision for advanced decision support.
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For more information see here:
MO are one of the very few who have made major strides at a state-wide level making a difference in improving clinical communications and for them to be this worried should ring alarm bells everywhere.
It seems to me NEHTA is focussed on destroying working properly standardised clinical messaging providers (Argus, Healthlink, eClinic and MO to name a few) – while having nothing of their own to replace it while failing to work with what is already working and can do more, if allowed.
Read carefully and be alarmed, very alarmed!