Monday, July 12, 2010

We Are Heading Towards A Major Fiasco In Australian E-Health. Total Fragmentation and Dysfunctional Unplanned Directions.

I was prompted to start thinking about the messy direction we seem to be hurtling down in e-Health by a couple of things that have appeared over the last few weeks

First we have had the Telstra / RACGP announcement.

Telstra, GPs in e-health agreement

Telstra plays a card in the e-health game, signs MOU with the Royal Australian College of General Practitioners

  • AAP (Computerworld)
  • 09 July, 2010 07:49

The nation's GPs and Telstra have reached an agreement on the roll-out of "critical first step" e-health reforms.

The Royal Australian College of General Practitioners (RACGP) has signed a memorandum of understanding with the telco giant, outlining a range of hi-tech services to be brought online from next year.

The first would allow the nation's 17,200 GPs to access health care applications, diagnostic tools and an array of other clinical and administrative software programs using a "single log-on" web service.

"A web-hosted service will make GPs lives easier (allowing them to) access applications from anywhere - from their practises, homes, hospitals or aged care facilities," RACGP president Dr Chris Mitchell said in a statement on Thursday.

"GPs are busy and the implementation of a national e-health strategy might seem daunting, however ... this collaboration will make it easy for general practise to take advantage of the new technology we now have available."

The web service, to be operating from July next year, would also end the current need for clinics to each purchase their own copy of the software used by their GPs.

More here:

The same issue is also covered here:

Telstra to provide e-health cloud to GPs

By Suzanne Tindal, on July 8th, 2010

The Royal Australian College of General Practitioners and Telstra have this week signed a memorandum of understanding that will hopefully see the telco provide software as a service to the college's members.

Over the next few months, the college will hold working groups with members and stakeholders to decide on specialist medical systems it would like Telstra to provide via the cloud.

These could include clinical software programs, decision support tools for diagnosis and management, care plans, referral tools, e-prescribing tools, as well as a range of online training and other administrative and clinical services.

Once systems have been decided on, Telstra will provide access to them using a T-Suite-backed single sign-on platform, according to Dr Chris Mitchell, president of the Royal Australian College of General Practitioners. The College has 17,200 GP members.

"GPs are busy and the implementation of a national e-health strategy might seem daunting. However, staying up-to-date and making sense of the latest technology is important," Mitchell said. "A web-hosted service will make GPs' lives easier. A web-based solution means GPs can access applications from anywhere; from their practices, homes, hospitals or aged care facilities."

No money has changed hands and no contracts have been signed, with Mitchell saying that the arrangement was very much at the beginning of its journey.

Mitchell thought that some of the general applications already on T-Suite could now benefit the college's members, but hoped that more medical-specific software would make its way onto the Telstra cloud platform within the next three to six months. Certainly he hoped to see software made available before July next year.

"We're really keen to get started on this very quickly," he said.

Telstra sounded more cautious. Telstra spokesperson Rod Bruem said that existing desktop software apps would move across to the platform by mid next year with beta testing to be carried out later this year.

More here:

When examined a little more closely what this announcement is really all about is moving the GPs who sign up to an application suite, delivered over broadband, using Software as a Service techniques.

The software available at present from this service includes anti-virus, financial, HR management and CRM applications. According to the Telstra website the actual GP or clinical software is exactly zero, as far as I can tell.

See here:

I just note in passing the recent articles on cloud computing security. For Health Information we really want near total security.

Secrecy of cloud computing providers raises IT security risks

(07-06) 04:33 PDT -- Despite how attractive cloud computing can sound as an outsourcing option, there's widespread concern that it presents a security and legal minefield for businesses and government. Cloud service providers often cultivate an aura of secrecy about data centers and operations, claiming this stance improves their security even if it leaves everyone else in the dark.

Businesses and industry analysts are getting fed up with this cloud computing version of "don't ask, don't tell," where non-disclosure agreements (NDA) dominate, questions aren't answered, and data center locations and practices are treated like national security secrets. But public cloud service providers argue their penchant for secrecy is appropriate for the cloud model -- and at any rate, everyone's doing it. They often hold out their SAS-70 audit certifications to appease any worry (though some don't have even that)."The business data you store in Google's cloud is safe," said Google product marketing manager Adam Swidler at the recent Gartner security conference held in National Harbor, Md. He emphasized that Google's multi-tenant distributed model entails "splicing data across many hard drives" so that in this "hardened Linux stack" there's a "quick update of all fragments of all files in the hard drives," a process he called "obfuscated files."

Swidler acknowledged there has been some secrecy about where things are located because "we think it's a security risk." Nonetheless, "Google is trying to open up a little transparency in what we do," he said.


Not satisfied with all this in recent times we have had all the fruits of the NEHTA sponsorship of the RACGP with announcements on such areas as:

Mental Health:

to say nothing of RACGP involvement in Medisecure and all the paid enthusiastic spruiking of the Health Identifiers.

There must be a very keen business development person at the College casting around for e-Health press release opportunities!

Read more on this here:

and here:

Additionally we have had announcements from the Commonwealth Government about Patient Controlled EHR and an implementation plan that makes little if any sense. See here:

In the background we still have only patchy progress on e-prescribing with Standards as yet un-delivered and un-adopted.

Step back for a moment and consider this:

In a presentation in August 2009 Adam Powick of Deloittes, who developed the agreed but still unfunded Nation E-Health Strategy, said on his slide 10 and 11.

Conclusion –the next 12 months are key

•Initial set of national eHealth foundations will be delivered

•Government’s response to reform commission report will be communicated

•Significant eHealth progress planned across all State/Territory jurisdictions and key parts of the private sector

•Beginning of meaningful on the ground collaboration in areas such referrals and discharge summaries

•A number of personal health record solutions will become available to Australian consumers

•Delivery of a national ePrescription capability

Conclusion –the need to work together

We are poised for significant progress but still could easily fragment the national agenda into 1000 moving parts.

What is needed is:

Clarity, Focus, Pragmatism, Leverage, Collaboration.

---- End Slides.

I would add we also need leadership and relevant competent governance. We are not getting any of this and Adam’s prediction get closer by the day I fear. I would also note a lot of what Adam thought would happen has not actually happened yet.

There is a lot of un-coordinated Brownian Motion happening right now and the risk it will all implode and waste heaps of money rises daily!



Anonymous said...

You say: What is needed is Clarity, Focus, Pragmatism, Leverage, Collaboration.

Those are great words, no-one would argue with on that score. But in the context of ehealth and a complex, turbulent, changing environment undergoing the largest reform and restructuring in 30 or more years I have to ask what exactly do each of these words mean - Clarity, Focus, Pragmatism, Leverage, Collaboration. In the literal sense we all know what they mean, the Oxford dictionary definition is very clear.

However, it is in the practical sense that I ask the question. More specifically at a national, state and local level, at a large and small software developer level, from an implementation perspective and from an end-user perspective ask your self what are these words intended to convey and how can they be applied to achieve better results and outcomes that we have witnessed to-date. Please don't rush the answers - think long and hard first.

Dr David More MB, PhD, FACHI said...

Not my words - but Adam Powick's - to which I added leadership and governance.

The key message is as it always has been that we need an agreed plan about how to move forward that involves all those you mention. We need a rational process, some sign on and some funds with all that as well.

Sadly we actually had a reasonable plan delivered almost 2 years ago - that, like so much else with Government, has been cherry picked and we seem like we will wind up in a worse mess than before.

I might be wrong - but the evidence right now suggests I have it spot on.

The words specifically ask that we align, agree and move forward..not just puddle around as it seems we are now.


Anonymous said...

Brownian Motion is a very apt description.

The following Wikipedia piece is very informative.

Scroll dow to the HISTORY section and look at the graphical representation reproduced from the book of Jean Baptiste Perrin, Les Atomes.

Further on we have this superb description:

Consider a large balloon of 10 meters in diameter. Imagine this large balloon in a football stadium. The balloon is so large that it lies on top of many members of the crowd. Because they are excited, these fans hit the balloon at different times and in different directions with the motions being completely random. In the end, the balloon is pushed in random directions, so it should not move on average. Consider now the force exerted at a certain time. We might have 20 supporters pushing right, and 21 other supporters pushing left, where each supporter is exerting equivalent amounts of force. In this case, the forces exerted towards the left and the right are imbalanced in favor of the left; the balloon will move slightly to the left. This type of imbalance exists at all times, and it causes random motion of the balloon. If we look at this situation from far above, so that we cannot see the supporters, we see the large balloon as a small object animated by erratic movement.

That's ehealth in all its glory.

Anonymous said...

and NeHTA too, particularly the bit where it says "it should not move on average". How true is that.