The Committee is part of a really labyrinthine management structure which has to be causing some of the grief we are currently feeling in e-Health.
Just where it fits can be figured out by downloading this small 2 page PowerPoint presentation.
www.aihw.gov.au/committees/health_reporting_structures.ppt
The committee of which I speak is the grandly named:
Joint Standing Committee on Health Informatics Standards
As far as one can tell the committee reports to the National E-Health & Information Principal Committee. This in turn then reports to the Australian Health Ministers’ Advisory Council (AHMAC) which then reports to the Australian Health Ministers’ Conference (AHMC) which is the ‘top banana’ and which feeds in to the Council of Australian Governments (COAG).
All this can be reviewed here:
http://www.ahmac.gov.au/site/home.aspx
Having come upon a document which said it was commissioned by this group I was curious to see where it all fitted and having found this also discovered, from page 2 of the slides, where the National Health Chief Information Officers Forum (NHCIOF) fitted and that there actually exists a National E-Health Strategy Project Steering Committee – if this document is correct. I wonder where the minutes of these committees hide?
The report I found had this title:
Identification of Priority E-health Standards
Project Report
Joint Standing Committee on Health Informatics Standards
Final - Version 1.2
April 2010
The Executive Summary reads as follows:
Executive Summary
Convergence e-Business Solutions and SecureWorx Consulting were engaged by the Joint Standing Committee on Health Informatics Standards (JSC-HIS) to “identify priority e-health standards that are requisite to the progress of e-health within Australia”. We were assisted in this project by the JSC-HIS and an invited Stakeholder Reference Group comprising jurisdictions and a number of health informatics specialists.
The starting point for the project was the collected works-in-progress and plans of Standards Australia Health Informatics Sub-committee IT-14 and NEHTA which were mapped these against 12 agreed priority e-health components. The components were drawn in the main from the National E-Health Strategy, which we assumed to be the best available expression of the agreed requirements for e-health in Australia.
The mapping of standards against e-health components incorporated three independent weightings: the relative importance of the components themselves; the criticality of each given standard to progressing the components; and the amount of effort needed to complete the development of each standard. Values for all of these weightings were determined by surveying the Stakeholder Reference Group and taking the median value of their responses.
A spreadsheet was developed that implements the mapping model, applying the weights to each standard, and assigning it an overall score. After ordering the standards, they were allocated to four evenly divided quartiles, and assigned overall priorities on a four point scale.
The result of this analysis was a list of 21 standards that, in the absence of other considerations such as specific project imperatives or requirements deriving from a broader context, should be given top priority in development in order to progress e-health in Australia. As a final quality check, the output of the model was then reviewed by a group of selected subject matter experts to identify any inconsistencies in the analysis and any gaps in the resulting priority list.
The results of this work should not be taken as the final word in setting development priorities for e-health related standards in Australia. Neither should the results be regarded as being beyond reproach. Several relatively narrow considerations, which were accepted in the proposal and the methodology as it was developed, can be expected to have biased the results. Most significantly of course is the explicit reference to e-health. Thus, a standard that might be considered indispensible to hospital procedures or general practice for instance, will not have been rated highly by this treatment. Further, a standard deemed critical by one jurisdiction to a defined e-health program may have been weighted down if no other jurisdiction considered it particularly important.
A remarkable finding of our surveys was the great variance in priorities assigned to the 12 national components by various state health agencies. For the components Prescriptions, Care Plans, Decision Support for Tests, Chronic Disease Management and Secondary Interfaces, priorities ranged right across the board, from highest to lowest. Only one component (Referrals) was uniformly rated by all respondents. While the National E-Health Strategy defines clear priority areas, we found that there remains significant disagreement about the relative importance of those areas. This exposes the main limitation of our methodology: its statistical rationale is weakened in the event that there is not sufficient underlying agreement amongst stakeholders about what e-health itself needs to achieve. By the same token, we suggest that the tool and the collaborative discovery of stakeholders’ views about e-health imperatives serve to usefully uncover and catalogue the many competing interests. Therefore the process itself is of value for raising visibility and providing stakeholders fresh opportunities to understand one another’s issues.
We believe the model and the analysis tool developed here to be a useful new way to demonstrate the relationships between standards, and their respective contributions to realising e-health objectives. We suggest that in further work, the tool be used to help facilitate debate and resolution of priorities amongst jurisdictions and other stakeholders.
During the course of this project, the consultants observed the working relationship between NEHTA and Standards Australia. This relationship operates effectively and the two organisations cooperated strongly on the standards prioritisation process. In a complex multi-facetted area, both bodies exhibited a remarkable level of agreement on all substantive matters.
The development of standards for e-health in Australia is largely driven today by Standards Australia and NEHTA, in cooperation with other agencies, such as HL7 and IHE Australia, who bring specific relationships with organisations in the international health standards arena. Convergence/SecureWorx believes that the current working relationship between the two organisations has shown to be effective in advancing the development of standards for e-health and we see no reason to change their role in this regard. We recommend that these two organisations continue to perform their central role in the development of e-health standards.
Finally, the project has identified the need for some overall coordination in the timing and prioritisation of standards development to meet national e-health objectives. To this end we recommend that the role of NHISSC be extended to include reviewing and where necessary, setting, the priorities for the development of e-health standards in supporting Australia’s strategic e-health goals. This work should be undertaken collaboration with the NHCIOF.
----- End Executive Summary
The full file is not available on the web so I have made it available here:
http://moreassoc.com.au/downloads/E-health%20standards%20Final%20Report%202010-04-29.pdf
All this raises a few interesting questions.
First just why is such work being done at the behest of a very obscure committee which may have major impacts on e-Health priorities and capabilities essentially in secret from the broader e-Health Community. The Steering Committee as made up of public sector health bureaucrats and the Project Reference Committee as very thin on the ground in terms of both primary care and private sector input.
A search using Google and Bing find 4 hits and no minutes of meetings etc. I believe this utter lack of openness is a problem and is symptomatic of the narrow health department centric approach adopted by DoHA and NEHTA and their masters which is getting key directions totally wrong in my view.
The internal disagreement on priorities in the Executive Summary makes all this quite clear.
The second obvious issue is, with the new, recently announced funding, how are we actually going to mobilise coherent appropriate investment if there is this sort of priority differences? The answer is that the risk of throwing good money after bad is very high when things are managed in this fashion.
The PowerPoint (which is dated Mid 2009) is really a guide book to the totally failed e-Health Governance approach which must be swiftly opened up, made transparent and broadened to include many more stakeholders and experts.
The third issue regards what other reports this group have commissioned that should be more widely know?
All this poses a ‘clear and present’ danger to any success with this new money in my view.
David.
2 comments:
Grandly named it is .... but it is going to have to stand pretty damn tall to be seen and heard above that lot. So many committees. As the saying goes 'too many cooks spoil the broth'. Is it any wonder we have such a schmozzle of a mess with ehealth. Master Chef - eat your heart out.
You sum it up so well when you say “The answer is that the risk of throwing good money after bad is very high when things are managed in this fashion.”
Have a look at this:
“Thus, a standard that might be considered indispensable to hospital procedures or general practice for instance, will not have been rated highly by this treatment. “
“Further, a standard deemed critical by one jurisdiction to a defined e-health program may have been weighted down if no other jurisdiction considered it particularly important.”
“This exposes the main limitation of our methodology: its statistical rationale is weakened in the event that there is not sufficient underlying agreement amongst stakeholders about what e-health itself needs to achieve.”
I’m speechless. Is this how eHealth priorities are determined and decisions made down there in Australia?
As your previous commentator asks “Is it any wonder we have such a schmozzle of a mess” .
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