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Tuesday, April 27, 2010

Condemnation of Federal Government E-Health Policy is Mushrooming - And For Very Good Reason!

As I indicated in my introductory notes to the Australian Health IT Links yesterday – see here for details:

http://aushealthit.blogspot.com/2010/04/weekly-australian-health-it-links-26-04.html

We have hit an absolute wall in terms of the level of confidence and trust placed in the present Federal Government by many in the e-Health Community.

First published today we have Dr Andrew McIntyre of Medical Objects.

eHealth – Where is the duty of care?

After watching the failure of the Government Home Insulation Scheme and the Payroll issues with Queensland Health unfold its clear that the eHealth issues in Australia are part of a much bigger problem.

There is enormous potential for eHealth to cause damage and there is a duty of care to make sure the risks are minimised. Currently the push to roll out parts of the eHealth agenda is just as flawed as the home insulation scheme and the payroll system. We need to get some basic quality controls in place first or the consequences will be worse than what we have seen with these programs. Poor, missing or incorrect patient data can be just as deadly as Foil insulation in the hands of untrained installers.

Nehta, I am sure, has some great talent in its ranks, but I don’t see anyone with an overall understanding of the issues that face eHealth or how to fix them. They are unwilling to listen to the practical concerns of people with experience and now it seems they are under political pressure to deliver and just like these other rushed programs the risks are very high.

I have multiple levels of concern, but chief amongst them is to try and steamroll connectivity in a physical sense when in a practical sense it is badly broken. The quality of the data being moved is low and very non-compliant with standards and this is well known. There appears to be a block on the idea of a quality program for the messages, despite the machinery to do this at a basic level existing for over 5 years. Applications fall over importing good data and often fail to display it correctly and in many cases can’t support HL7 (Health Level 7) at all. Blindly sending data around, even with shiny New Health Care identifiers is a recipe for disaster.

Read the rest of the blog here:

http://blog.medical-objects.com.au/?p=52

Just before this appeared we had the following appear in Tuesday’s Australian.

E-health is Kevin Rudd's little orphan Annie

THE glaring omission of e-health in the Rudd government's long-awaited national health and hospitals reform package has stunned and dismayed the IT industry.

"The missing link is health IT," said Health Informatics Society of Australia president Michael Legg.

"There was every expectation e-health would be addressed in the Council of Australian Governments agreement, as the National Health and Hospitals Reform Commission made it clear the reforms had to be underpinned by a robust IT infrastructure.

"But e-health is notable for its absence in these announcements."

Deloitte partner and lead author of the National E-Health Strategy, Adam Powick, said that while disappointing, the outcome was "hardly surprising, given the political nature of the negotiations".

"Spending on hospital beds, doctors and waiting lists has always taken precedence over health IT," he said.

"But I observe the Prime Minister promised these reforms would lead to a better integrated, better co-ordinated healthcare system, and the only way you can do that is by improving the flow of information across geographic and private-public boundaries.

"And that requires investment so we can electronically connect healthcare systems."

While Kevin Rudd said in his National Press Club speech last month that the national structural reforms would build a health system for the 21st century, Mr Powick said: "We are now a decade into the new century, and many parts of the healthcare system are still reliant on bits of paper, human memory and patients lugging their X-rays around."

Mr Powick said it was critical for the government to make a "meaningful investment and commitment" to e-health as part of the budget process.

"If we do not get that, our chances of working towards a co-ordinated national e-health agenda will be seriously jeopardised," he said. "E-health is going to happen. You're not going to stop it, particularly with the explosion of mobile solutions we've seen with the iPhone and will soon see here with the iPad.

"The question is whether we can deliver e-health in a co-ordinated, aligned fashion, or is it going to be fragmented and extremely difficult to integrate across healthcare boundaries."

The views of many other, very unhappy, heavy hitters are found here:

http://www.theaustralian.com.au/australian-it/e-health-is-kevin-rudds-little-orphan-annie/story-e6frgakx-1225858544370

The sole response from the usual Department of Health Spokesperson is to remind us of the funds COAG provided, a year or two back, to fund that paragon of successful delivery, transparency and effectiveness NEHTA.

We can only be grateful that there is beginning to be some political glare shone on the way all this has been handled.

The simple fact is that what the Government wants to do with its really rather less than ideal Health Reform package is just not deliverable without a substantial, well planned and well delivered upgrade to the Nation’s E-Health Infrastructure.

To pretend this is not true is just arrant nonsense – something we seem to be seeing more and more from this Government sadly. The sudden decision to just bale out of attempting to address climate change following on the policy weaknesses in so many other areas becomes a source of serious concern for me.

I suspect we will be seeing cartoons like the one linked here more and more often.

http://newmatilda.com/sendstudio/display.php?M=15105&C=1270b3fd039b30a06d4629443c17afca&L=9&N=685

Bluntly to me is what we have is e-Health ignored in the context of Health Reform that is hardly worth the name and that has all the hallmarks of being an overly complex, poorly conceived implementation disaster!

We are seeing the first serious hints of this already.

POLL: Most GPs will snub diabetes scheme

30th Apr 2010

Andrew Bracey

GPs are set to reject the Rudd Government’s contentious plan to overhaul the management of patients with diabetes.

A Medical Observer poll has revealed that just one in five GPs plans to adopt the new model, which is set to begin in 2012.

Under the controversial $436 million scheme, practices will receive block-funding worth up to $1200 for each patient they enrol, plus annual payments worth an average of $10,800, which will be based, in part, on GPs’ performance in keeping patients healthy and out of hospital.

Additional upfront payments of $1500 per practice were also offered to sweeten the deal.

Announcing the scheme earlier this month, Federal Health Minister Nicola Roxon anticipated 60% of practices would sign up within the first year.

More here:

http://www.medicalobserver.com.au/news/poll-most-gps-will-snub-diabetes-scheme

Proper planning for policy implementation requires road testing of policies carefully before rushing in. Seems like not much of this happened here!

Pretty sad that.

David.

2 comments:

Anonymous said...

AM Blog: Andrew, if NEHTA's interconnectivity work is putting the cart before the horse, why are you supporting it commercially (Argus collaboration etc)?

KD Article: Why is it the case that people that are actually delivering e-health solutions never get sighted asking for e-health funding? Why are the loudest advocates for government handouts consultants and vendors with marginal business models?

From where I sit, Australia has a long track record of squandering govt money dished out for e-health, a proud tradition that continues with NEHTA today. Perversely, it seems the more money that is devoted to e-health, the slower the progress. Surely throwing more money into the fire will only produce more smoke?

Haven't we seen two classic examples of the how government has no idea how to allocate funding in a way that enforces accountability (pink bats and school halls)? Compared to administering a few tradies putting foam in a roof, surely staying on top of e-health expenditure and measuring deliverables would be a tad more complex?

What do the folks with their hands out actually want the money for?

[no vague references to funding equally vague e-health strategies please - how about some specifics that stack up on a cost/benefit basis and have national (not local pilot) implications?]

Andrew McIntyre said...

Hi Anonymous,

The argus interoperability, or messaging interoperability in general is relatively easy at a physical level.

The problem is that there are so many specific requirements for application X to work correctly with a standard message that handing data off for delivery by someone else makes the reliability of delivery drop. Not the physical delivery, but the ability for the message to work seamlessly with the target application. Often to get the message to appear in the correct place or be imported at all involves specific handling of the message at the target site.

So interconnectivity just creates issues with reliability and this comes down to the ability of endpoints to accept standard messages. If they could then the messaging becomes the easy bit.

So our role is more related to making systems that would not normally work together function reliably rather then transferring X bytes from a to B. This is why a SMD specification on its own actually opens a Pandora's box of problems rather than solving problems.

In reality doing messaging has made us very experienced interface engine operators.

Andrew McIntyre