This is Not the Way to Go About Things but Despite That There Are Some Hopeful Comments.

This appeared a few days ago.

E-health record tenders out soon

• Karen Dearne
• From: Australian IT
• September 24, 2010 12:00AM

ELEMENTS of the planned personally controlled e-health record system will go to an open tender, with an industry briefing due before the end of the year.

Some details of the $467 million project to deliver electronic patient records "to every Australian who wants one" by mid-2012 have emerged in response to questions on notice since the Senate estimates sessions in May.

It's understood answers from the federal Health Department were on hold during the extended election caretaker period.

"The (Gillard) government's investment over two years will fund the core infrastructure, standards and tools to provide (everyone) with access to a secure PCEHR from 2012-13, if they chose to register for one," the department said.

"The priority projects for initiating the national system (commenced from) July 2010 with the initial focus on working with key stakeholders including consumer representatives, healthcare organisations, providers and states and territories to identify the design requirements.

"These early planning and development projects will build on the work already undertaken through organisations including the National E-Health Transition Authority and will include ongoing consultation.

"Elements of the national PCEHR will be procured via an open tender process and an industry briefing is expected to be held in the first six months of the program."

The Australian Health Ministers' Conference will oversee the development - rather than the Council of Australian Governments - with the AHMC due to consider a specific workplan and resourcing later this year.

With the federal government funding the first two years of the national rollout, "the states and territories are expected to make complementary investments to upgrade their health and hospital systems in readiness for connecting" to the new system.

"This will allow for a carefully planned and staged introduction of a complex operation, and allow governments, industry, healthcare professionals and patients to make the necessary investments and operational changes needed to participate in the national e-health records system," the department said.

"The first two years of funding will allow lessons to be learned and inform further stages of the roll-out. The government will evaluate progress and make future investments post these two years, as necessary, to expand on the range of functions delivered."

The government says the introduction of individual patient records is "a core element of the National e-Health Strategy" adopted by COAG in December 2008.

…..

An initial report on long-term governance arrangements is currently being developed in collaboration with the states, for consideration by the AHMC, which will manage the whole process.

More here:

http://www.theaustralian.com.au/australian-it/government/e-health-record-tenders-out-soon/story-fn4htb9o-1225928533259

What is right here is the recognition that some long term governance arrangements are being worked on.

What is wrong here is that The governance arrangements are being developed with the states and presumably the State Hospital Focussed CIO cabal rather than with all the important other stakeholders in the health sector. If that is actually happening, and the track record is not good, so far there has not been much apparent in the public domain.

Also it seems to me that having the AHMC (The Australian Health Minister’s Council) at the apex of governance of e-Health is going to lead - as it has always before - to very diffused accountability. The way you avoid this is to do what is done in the US and UK where a powerful executive is given a brief to get something done, the resources and authority to do it and simply gets on with it. Without leadership and accountability of that sort we won’t get far again.

It also needs to be pointed out that this quote is having the Government play fast and loose with the truth.

“The government says the introduction of individual patient records is "a core element of the National e-Health Strategy" adopted by COAG in December 2008.”

The National e-Health Strategy said there was a great deal to do in all sorts of areas before shared records / IEHR was to be developed - and that it should be done incrementally at a regional level. It was the much later National Health and Hospital Reform Commission (NHHRC) that came up with the PCEHR as the priority.

This paragraph points out just what needs to be done first.

“As a result, national action will focus on four key areas: infrastructure and rules for access and sharing of patient information; stimulating investment in high priority computer systems and tools; encouraging healthcare providers to adopt and use advanced tools, and establishing a governance regime for effective coordination and oversight of e-health activities.”

It seems to me that what should be happening is that we get governance and leadership in place and then ask of them to develop plans for progress and procurements - going out and procuring until all the wrinkles are sorted is yet another recipe for disaster. We have waited for over a decade - a few more months at this stage to ‘get it right’ won’t be a disaster.

I also have to say this nonsense of funding for 2 years and then trying to work out where next? is just a prescription for a disaster. If you are going to do it, do it once, do it properly and so it with fibre, oh I mean commitment!

I really wish some strategic sanity could prevail here rather than the ‘fire, ready, aim’ approach this seems to betoken.

The most recent poll would seem to confirm a lack of confidence about how this is being handled.

See here:

http://aushealthit.blogspot.com/2010/09/aushealthit-poll-number-37-results-26.html

David.