This has just been posted on the Medical Objects Web Site:
Well we have had the election and there is no clear winner but it appears that the Rudd/Gillard government is the loser. eHealth is up for some reassessment and it certainly needs some.
From all reports $5 Billion of taxpayers money has been spent over the last 10 years and we have little to show for it. 10 years is long enough for any reasonable plan to bear fruit and there is clearly some fundamental flaw in the methodology.
The decision to purchase a SNOMED-CT license, and a Certificate Authority is the only positive I can find. We do have a Secure messaging standard, but it is flawed by the fact that it really depends on Nehta “NASH” service for suitable certificates rather than working with the existing Medicare certificates. (and NASH is vapour ware) Virtually every general practice has Medicare certificates as part of the PIP program and the reason that the secure messaging standard was not designed to work with them lies with the dysfunctional relationship between Nehta and Medicare.
Dysfunctional organisations seem to be at the heart of the matter. We have not had one organisation for 10 years, but about 4 or 5 each of which has been rebadged and restarted only to repeat the same mistakes. That mistake, or the core of it is the idea that they have to “solve” the problem and produce software. Government is hopeless at doing this, indeed most large organisations are hopeless at producing software and large projects tend to fail. What we need is government to provide governance to move the industry forward rather than trying to do the heavy lifting. After 10 years the things that were working at the start are still working and all the things that are working are based on consensus standards. What we need is governance to comply with those standards and progress the standards in an incremental way. Currently we see much talk of Nehta inventing standards and despite some very capable people inside Nehta this is doomed to failure. Standards have to be created by consensus, as then the industry will engage with the painful standards process in order to prevent silly ideas becoming a standard and to fix errors where they occur. They will only engage when they know they have a duty to comply with the standards and this is where the lack of governance is failing us.
The standards process has become orphaned because Nehta have said they will be dictating the path, and they have failed to produce any clear path. More recently they have tried to steam roll standards and this is also likely to fail as without adequate review the standards will be poor.
Out there is the real world, which is the world that Medical-Objects inhabits, we see significant advances in communication with the number one obstacle being poor standards compliance. Because of a lack of governance large vendors feel that they can flout the standard and dictate the formats though sheer market size. Because of a lack of compliance anything that does work is fragile because it is never quite right, but has to be wrong in exactly the right way in order for it to work.
The dreams of the connected health landscape are often formulated by people with no knowledge of the importance of the lower levels. We can connect to the whole world of internet services because of compliance with the invisible things like tcp/ip and http standards and not because some middle manager dreamed of the internet. The dreams of a connected eHealth world rely on applications supporting the creation and consumption of high quality, standards compliant messages and not on the glossy pdfs produced by Nehta.
I don’t think we need Nehta, the states are not the eHealth leaders in this country and Nehta was setup as an uneasy alliance of the states, many of whom ignore Nehta anyway. What we need is good governance and a focus of standards compliance of all the applications that make up the landscape. There does need to be funding of the standards process and there needs to be a mechanism for providers of healthcare to pay to buy standards compliant software, which is built properly will be more expensive than they are paying now. However, the money they are saving is working against the big picture of a connected landscape and this is where governance and some well directed funding could make a huge difference. If every health application was required to be standards compliant we would see an enormous spike in interest in the standards process and the consensus process could be resuscitated for its premature death and we could start moving forward one level at a time.
The big bang process has failed, as it was bound to do and we need a return to proven paths. The cost would be a fraction of what was planned and the results, though slow would be much more solid. The tortoise is still in the race, it’s time to stop trying to follow the scatterbrain hare!
The blog is found here and is cross posted with permisson:
It will be fun to watch the apoplexy over on the NEHTA Sponsored blog!