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Monday, June 28, 2010

The Medical Software Industry Speaks on The Future of E-Health in Australia.

A week or so ago the General Practice Network held an e-Health Conference.

AGPN eHealth Conference 2010

In response to the health reform environment and in recognition of the fundamental role of eHealth as an enabler of this reform, the Australian General Practice Network (AGPN) will be hosting a National eHealth Conference in Melbourne on 16 – 17 June 2010.
The conference will focus on the key theme of 'connecting the health care sector'.
The topics of connecting up the health sector and aligning eHealth activity behind a common national strategy will be explored. Also addressed will be the role of the general practice networks in the delivery of enabling eHealth infrastructure across primary health care.
Participants in this event will include representatives from the general practice networks, national eHealth organisations, governments, allied health and specialist communities, vendors and health consumer groups.
----- End Extract
A web site covering this is event is found here:
I understand many of the presentations from the event will be posted in due course at this URL.
The president of the Medical Software Industry Association (MSIA) (Geoffrey Sayer) gave a very interesting presentation on the 17th entitled ‘Vendors on the front line: 17th June, 2010’.
Of special interest were the following slides:

Slide 5: e-Health Observations.

·         There is an urgent desire to hurry up and deliver e-Health but we are asked to wait –again!
·         e-Health has to combat silos but most initiatives are silo based and not aimed at the intersecting points in healthcare
·         e-Health is an enabler -Primary Care is fundamental to health care -but GPs appear late comers to the engagement process for e-Health
·         Everyone will have HI -industry, government and the profession agree on the benefits –but we are not looking to fast track the benefits
·         Two years to demonstrate benefits of PCEHR but longer time table to deliver the actual building blocks
·         We have examples of what works and what doesn’t -but seem to pursue the approaches that in the past haven’t worked
·         Patients don’t need to know their HI -or be concerned about it -but are expected to demand the benefits of a HI
·         e-Health is considered deterministic in nature yet healthcare is probabilistic
·         e-Health doesn’t face the same effectiveness analysis as other interventions do
---- End Slide:
From this I take, at the least, the MSIA is seeing a lack of co-ordination and direction in how e-Health is being planned and prospectively delivered.

Slide 6: HI Service: Vendors Perspective.

  • The HI Service provides clear benefits to the Australian people and establishes a critical building block for an e-Health enabled health care system
  • The passing of legislation is crucial and industry supports the passing of the proposed legislation and regulations
  • However, when approved everyone will have a IHI but little will have any benefits for many years to come under the proposed approach
  • Medicare will be from the outset incurring cost of production and support whether any one is accessing the HI service or not
  • The estimated savings and benefits will not be realized unless the HI’s are functioning across the whole sector in the actual exchanges of information

Slide 12: HI Service: Vendors Perspective

MSIA have been very clear in vendors’ desire to deliver the benefits of HI Service through:
·         Timely delivering of capability across all sectors
·         Well specified requirements
·         Use of standards
·         Robust testing and infrastructure capabilities
·         Appropriate CCA
·         Effective support and education of end users
·         Appropriate business and financial drivers

Slide 13: Implementation Approach -Concerns

  • Apparent acceptance of a extremely slow uptake of the HI Service
  • Lack of community based initiatives i.e. GPs, Specialists, Diagnostic services
  • Talk of a tipping point with no detail beyond jargon buzz word terminology
  • Lack of understanding of business drivers that have successfully worked before in driving e-Health initiatives
  • A strategy of relying on a “controlled release” and “lessons learnt” from early adopters that have the right to refuse the use of those lessons under confidentiality clauses
  • Effective evaluation of any impact or benefits of HIs
----- End Slides
From these three slides I detect conviction that the HI Service – done right – will be a very good thing but that there is also a sense that right now it is not being done right.
Further on in the presentation there are two key themes.
First that the NEHTA ‘laissez faire’ approach to the tempo and focus on implementation of the HI Service had a huge opportunity cost associated, in safety and care quality  – and may I add also risks every one simply looses interest!
Second that the processes for Compliance, Conformance, Certification and Accreditation of Software and Services need some serious funded national attention, and soon.
Readers of this blog will recognise I believe all this is utterly correct – and very much parallels things I have been saying.
It is really way beyond time the ‘powers that be’ drop their arrogant ‘don’t you worry about that’ approach and get on with either providing competent leadership and governance or simply being disbanded.
Hopefully with the new Prime Minister we may see some more co-operation with industry, and a more vigorous effort to address the e-health needs of the whole Health System.
Thanks Geoff for sharing the MSIA perspectives.
David.

12 comments:

Anonymous said...

Geoff Sayer's presentation went down like a flat balloon. It was dull, opinionated and assertive.
Geoff desperately requires a PR makeover
Perhaps David you can help here?

Anonymous said...

When I read these slides I thought - so, we’ve heard all this before. Please don’t misunderstand - sometimes the cracked record just has to keep going round and round and round and round. But I have to ask - what is the MSIA doing?

Is it speaking for all vendors? or for its members? or for some of its members?

Has it got any traction with the power players, the government, the bureaucracy?

Is it capable of influencing outcomes and the way forward for ehealth?

I don’t get any joy from asking such questions because the answers which come back are pretty shallow and superficial.

One can look back to many occasions over years gone by where the MSIA in all good faith and with lots of energy has stepped up to become a voice to lead the way with its members behind it, energised to make things happen and then kappooof - it all goes up in smoke, vendors disagree and go their own ways and the whole cycle starts all over again. Then the blame and finger pointing begins and it’s the bureaucrats, the Department and Nehta who are at fault. Are they the bad guys? Or is the health informatics industry too precious, too hard to work with or just plain immature?

These are hard questions. The fundamental questions should be:

What is the purpose of the MSIA in relation to ehealth?

Is it fulfilling its purpose?

How should it be fulfilling its purpose?

And what does it need to do that?

I read the slides again and I felt even more depressed. A few extracts is all it takes:
- combat silos
- GPs are latecomers
- we pursue approaches that in the past haven’t worked
- ehealth is deterministic but healthcare is probabilistic (read that one again Henry)
- lack of community based initiatives
- no detail beyond jargon buzz word terminology.

It leads me to ask one more time:
What is the purpose of the MSIA?

Can its members make it a force to be reckoned with …..
…………….. or would they rather not?

Anonymous said...

The MSIA represents virtually all the vendors that have already been succesfully doing for many years what Nehta are saying they are trying to build a framework for - and that is to deliver diagnostic reports and other patient centric reports from providers to referrers. The MSIA therefore has a very important role to play in the process which wil begin to change with the advent of the HI which all players played a role in - DOHA, Nehta and the MSIA.
It would perhaps be more fitting for you to question what has Nehtas role been in facilitating ehealth in Australia. Have they spent the Australian taxpayers $350million wisely so far and will they produce something else with the next $400million. Time will tell but history says no

Anonymous said...

It is indeed fitting "to question what has NeHTAs role been in facilitating ehealth in Australia."

That indeed is a role we should expect MSIA to drive, drum and bugle home without let up. To reach into the ears and minds of politicians who care about our health system. That is a role that MSIA could and should be playing and one it should have been playing for a very long time. Sadly however there seems to be little evidence MSIA has done that, rather the evidence points to one of an organizaion pussy-footing around the edges terrified lest it upset its members who may elect to distance themselves from it by resigning their membership.

"Have they spent the Australian taxpayers $350million wisely so far and will they produce something else with the next $400million. Time will tell but history says no"

Oh goodness gracious me. If that isn't an opener for MSIA to stand up and be heard I don't know what is. By the way, that's not the first opportunity to come the way of MSIA and its members and it certainly won't be the last whilst the MSIA and its members continue self-flagellating with their heads stuck up their petticoats like a bunch of frightened Nellies.

Geoffrey Sayer said...

I have been somewhat amazed by MSIA members for the passion and drive to make a difference to their customers and the end patients in what is a tough and complex business.

In terms of whether MSIA is a force - it has grown from 36 members 12 months ago with numbers closer to 100 - I expect that growth to continue. We cover the big, little and in-betweens companies. We cover hospitals, GPs, specialists, diagnostic services, allied health, secure messaging, EHRs, aged care, pharmacy, knowledge systems, security – check out our website for more details. For many of those segments our members represent well over 95% plus of the market they operate in.

I often get asked why the sudden growth.

Simply the MSIA is providing a common voice for its members when others are ignoring the experience and knowledge these companies have in eHealth. MSIA and its representative are involved with over 40 plus vendor engagement processes. NEHTA engagements are the minority.

Sure you will get differences of opinion but you get that everywhere in Health. There is however one thing though that does unite the vendors - and I feel I really can speak for the members - is the desire to deliver IHI to the all patients across the healthcare systems in a timely, safe, cost effective and sustainable way.

The presentation given at the AGPN has come about from the frustration that was felt and expressed through the MSIA CEO forum where 70 CEO/decision makers from member companies supported the proposal that if IHI actually improve safety for patients why would you not want to fast track them? The AGPN presentation was focused on putting forward a model that showed waiting for incremental ‘laissez faire’ approach my come with an opportunity cost in terms of dollars and people miss-adventures.

It appears that some people (who shall remain anonymous) are not prepared to consider this argument or explore alternate options for fast tracking what we have been told and have believed for a number of years will be a significant step forward.

If IHIs won’t improve patient safety, or is a critical building block for eHealth, then there is no rush to roll them out.

Anonymous said...

When Geoff Saying is being opinionated and assertive, you'd do well to listen in and try and keep up.

As for being dull, if I had to present to a bunch of hangers on at an AGPN event, I'd be struggling for inspiration also.

Anonymous said...

Who allowed Geoffrey Sayer to be president of the MSIA? That's like putting Dracula in charge of the blood bank. No wonder Andrew Magennis resigned.

Anonymous said...

That's the MSIA for you, it is your representative, you are the vendors, you choose your leader and with one united voice MSIA represents all vendors to politicians, bureaucrats and NeHTA. As a little health informatics company we pay our fees to be at the table but we do so most reluctantly because we have no other option.

Geoffrey Sayer said...

Hello Anonymous (Tuesday June 29 10:13:00 PM)

It is amusing and sad to see where the debate has gone.

1. I put forward a view for debate yet you limit your response to name calling.

2. You allege Andrew Magennis retirement from MSIA was because of me becoming President.

The funny thing is - Andrew nominated me for President.

The sun is rising - I need to return to my crypt.

Anonymous said...

Nice one Geoff:-)

ST said...

I disagree with the tenor of the commentary and Geoff's slides. "Incremental" is exactly what we need. Point me to one large IT solution/system (particularly from the health sector) that has generally succeeded in its goals from the get go.

Sure, money needs to be spent. But it needs to be piecemeal and strategic because nothing, repeat nothing, ever works the first time. There needs to be more widespread acknowledgement that IT, through not too much fault of its practitioners, is very difficult to get right. Lessons need to be learned, requirements finessed and standards worked out.

I want the vendor community to be supported, but I also don't want it to be handed a bucket of many to sort it all out. They can't sort it on their own. A more strategic approach (laissez faire if you will) will reduce the amount of taxpayers money wasted and, more importantly, bring about a more effective outcome sooner (believe it or not)

ST said...

Oops...that is "bucket of money", not "many".