Sunday, October 10, 2010

We Can All Watch in Bemused Amazement as NEHTA Stuffs This Up. Sadly They Are Just Clueless at Implementation.

The following popped up a day or so ago.

NEHTA publishes health identifier plan

By Renai LeMay, on October 8th, 2010

The nation's peak e-health group has released a comprehensive set of documents that outline how the Federal Government's $466.7 million electronic health identifier project will be implemented over the coming years, and how it will work in practice.

The project is slated to see all Australians allocated a unique identification number enabling medical records to be transferred — with their consent — between medical providers such as hospitals and general practitioner doctors electronically, rather than through paper records, as is often the case today.

However, so far details on how it will be implemented have been scant.

In the documents, the National E-Health Transition Authority (NEHTA) said there would need to be three complementary programs of work to be undertaken for the project to move forward.

Firstly, a change management program would need to be carried out that would depend on what NEHTA said was the "nature of the healthcare business" and the current state of its IT systems. In this program, industry peak bodies will be involved as well as other organisations.

Secondly, NEHTA said medical software vendors would need to be provided with assistance so that their products could communicate with the healthcare identifier service. Well-designed specifications would need to be provided to assist with their implementation of standards.

Lastly, NEHTA said it would be necessary to identify and establish early adopter sites that could demonstrate the use of the technology in supporting outcomes. The organisation is planning to collaborate with key organisations that would be prepared to get involved early, which will produce lessons learned, research and toolkits from the process.

More here:

When I saw this I thought maybe we have a new era of openness and implementation competence emerging from NEHTA. Sadly it is just not the case in my view.

Actually far from being comprehensive what we are given in two documents (an HI Service Implementation Approach (39 pages) and a Communications Plan (15 pages) that are as high level and vague as is possible to be. They also are often rather naïve and uninformed about the world of Health IT outside Australia.

The guts of all this is found on page 14.

2. How will the HI Service be implemented?

Healthcare providers in both the private and public sector have made significant investments in technology over the past 20 years. Australian governments have agreed that any national program must recognise this investment and build on existing systems.

The HI Service has been established to:

  • Implement and maintain a national system for uniquely identifying healthcare providers and individuals;
  • Develop and operate a Healthcare Provider Directory to facilitate electronic communication between providers by enabling them to locate and verify the contact details of other providers;
  • Operate in conjunction with a standardised authentication infrastructure and comply with international best practice for information security.

A number of service channels are being established for both individuals and providers to access the HI Service. Healthcare providers (individuals and organisations) will be able to look up or enquire about identifiers from the HI Service via a secure business-to-business (B2B) web service, a secure web portal or telephone. Individuals will also be able to access their own information held by the HI Service through a web portal, by telephone or face-to face at Medicare Australia Offices. Patients will be able to find out which healthcare providers have accessed their IHI by reviewing an audit log held by Medicare Australia.

Identifiers have been automatically assigned by the HI Service Operator to all individuals enrolled in Medicare Australia’s and Department of Veterans’ Affairs (DVA) programs.

Those not enrolled with Medicare Australia or the DVA can be provided with a temporary (unverified) IHI when they seek healthcare, and can choose to validate (verify) this number through the HI Service by providing sufficient demographic information to ensure the IHI is uniquely assigned to that individual.

Individual healthcare providers have been issued with either a HPI-I as part of their professional registration process through the Australian Health Practitioner Regulation Agency or may obtain one directly from the HI Service.

Healthcare organisations will need to apply directly to the HI Service Operator to be issued with a HPI-O.

Healthcare identifiers are designed to improve information management and communication in the delivery of healthcare and related services. While identifiers are designed primarily for these purposes, there will also be benefits for other health-related purposes. For example the timeliness and accuracy of health research and management of health services could be improved through the use of healthcare identifiers. These purposes are specified in the Healthcare Identifiers Act 2010 and will be permitted only in accordance with rules for access.

----- End Extract

Having read this are you any the wiser as to how the HI Service will be implemented? I am not.

The more you read of the document the more you just shake your head in horror. Classics I noticed going through were:

Page 7:

In addition, implementation plans will be developed in consultation with parts of the sector, e.g. primary care, jurisdictions and aged care.

And, on asks, what about the rest of the health system?

Page 8:

The document refers to being guided by the National E-Health Strategy which remains unfunded and ignored except when convenient for DoHA or NEHTA.

Page 12:

The linkage between the HI Service, Identifiers and the claimed benefits is fatuous on any careful analysis.

Page 12:

There is a lot of discussion of the PCEHR but read here:

1.3 Personally controlled electronic health records

While the HI Service does not store any health information, it provides a foundation for future e-health initiatives such as the personally controlled electronic health records (PCEHR) that was outlined in the 2010-11 Federal Budget.

The national system will enable all Australians who choose to participate, to register online for their PCEHR from 1 July 2012. Australians will be able to check their health history online through their own electronic health record.

The PCEHR system will enable improved sharing of critical health information and better integration of patients’ care across multiple healthcare providers and settings. It will help patients experience smoother transitions between healthcare providers, reducing waste and inefficiency and enabling better and safer care that is more responsive to patients’ needs.

With a patient’s consent, the PCEHR system will allow an authorised healthcare professional to view a summary of health information from a range of providers. Summary health information will become richer over time and include key clinical information, such as conditions, treatments, medications, test results, allergies and alerts. The PCEHR system is a key building block in the National Health and Hospitals Network.

A key element of the PCHER system’s implementation will be through lead implementation sites that will test and evaluate key health information exchange between participating healthcare providers. This staged approach will ensure that lessons learnt through these lead implementation sites are responded to and subsequently, inform the future national roll-out of the system. This will enhance sustainability of the system and improve benefits to patients.

The purpose of the lead implementation sites will be to:

· Deploy and test national e-health infrastructure and standards in real world health care settings;

· Demonstrate tangible outcomes and benefits from funded e-health projects;

· Build stakeholder support and momentum behind the national PCEHR system work

· program; and

· Provide a meaningful foundation for further enhancement and roll-out of the national PCEHR system.

The PCEHR system will be underpinned by rigorous governance, national standards and planning, as well as core infrastructure requirements.

----- End Extract.

I find it interesting that this does not say these pilots are implementing the HI Service. If they all were one might have expected they would say so.

Page 15:

2.2 How will the health sector adopt and use identifiers?

The use of HIs will be progressively adopted by the health sector to support strategic initiatives and priorities at the national, state and territory levels including for example in the areas of medications management, discharge summaries, and referrals, as well as a future PCEHR program. Identifiers may be used for internal clinical purposes as well as for information exchange between healthcare providers. There will be different drivers across the healthcare sector for using healthcare identifiers. Most healthcare organisations will ultimately only adopt identifiers when their systems are able to support them and if they see value in making the change.

And lastly on Page 20”

“Based on overseas experience and feedback from Australian healthcare providers and their associations, the characteristics of B2B systems will be most appealing to small-to medium sized healthcare providers such as general practices, allied health professionals and specialists. These providers generally run efficient operations using standard off-the-shelf software. They are amenable to changing their business practices where there is a clinical benefit to be gained and where the change will not affect their efficiency or require significant retraining of staff. Access to the HI Service through a B2B connection meets these requirements.”

And there is the rub, as all providers can see at present in possible future benefit but real difficulties with avoiding major workflow impacts in the present.

I would suggest the big gaps here are as follows:

First there is not actually a real Implementation Plan! What we have here is motherhood and waffle

Second there is not an explicit allocation that leads to a resourced, funded and staffed implementation.

Third there is no clue as to how leadership and governance is to work - just saying Health Ministers will do it is a joke. Who is actually going to lead and deliver this do you imagine?

Fourth there is absolutely no firm rationale offered as to why anyone would go to the bother and expense of adopting the HI Service. The document talks of incentives but offers no concrete proposals.

Fifth there is no Resource Plan covering who, what, when, budgets etc. Without this you can tell this is one of those rather hopeful ‘Build it and They Will Come’ sort of projects. They don’t work often in my experience

Fifth note there are no explicit targets and timelines. Shows you they are not sure how it will go I believe.

Last, although the draft of all this was apparently put out for consultation there is no obvious summary of the consultation and change list from draft. Besides some graphics changes they are pretty similar.

You can read it all from this link:

The alleged comment made by a senior NEHTA official that “implementation is not NEHTA’s problem, and that they are there to design perfection’ sure rings true!

Watch this unravel - from their timelines it already seems to be behind. Without a properly resourced and led implementation, backed by appropriate incentives and undertaken with a solid well considered sector wide implementation plan (developed by project managers who know what they are doing) this is a dead duck!



Eric Browne said...

Notwithstanding anything you've commented about this, David, I would like to know how ZDnet managed to morph a pcEHR project into a Healthcare Identifiers project. In May this year, Renai LeMay wrote "The government will provide $466.7 million over two years to establish the key components of the personally controlled electronic health record system for Australia," at .
Yet now, the same author suggests these NEHTA documents are for impementing "the Federal Government's $466.7 million electronic health identifier project".
I'd also like to know what the total expenditure committed and foreshadowed for the HI services is. I know of the original $98million from COAG in 2006 for 3 years, and a further $52million committed by NEHTA to MedicareAustralia for the 2 years 2010/11 and 2011/12 from NEHTA's $218million 3 year allocation from 2008(?). Why Medicare should get $26million per year to operate a service that is not likely to be used in that period, is yet another mystery. And beyond all that, why would any additional money from the $466.7million be needed for the HI service?

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


What can I say?

All this detail is a great worry for those who wonder just what is actually going on.

I fear my conclusions are becoming even more likely to be right.


Anonymous said...

The combination of constantly moving goal posts, lots of mirrors, plenty of smoke, and a fist of disconnected 'stakeholders' like Medicare, DOHA, and NEHTA and associated multiple 'committees' / jurisdictions all equates to a deceptive picture; one which when convincingly presented contrives to make a story that nobody understands that is full of contradictions readily apparent to any logical thinking clear minded individual. So the game becomes self perpetuating because it becomes too hard to entertain any alternatives.

Anonymous said...

NEHTA said it would be necessary to identify and establish early adopter sites that could demonstrate the use of the technology in supporting outcomes. The organisation is planning to collaborate with key organisations that would be prepared to get involved early, which will produce lessons learned, research and toolkits from the process.

Why do they keep churning out the same paragraph year after year for the last decade? Have they learnt nothing in all that time?

Anonymous said...

The HI Service on its own is not much use. It is, rather, a stepping stone to interconnectivity. But there are other stepping stones required, such as a provider directory, ELS (or a standardised alternative) and NASH.

Anonymous said...

David you are an idiot. The $446.7 million you refer to is not for the HI rollout but for the entire Nehta stack with the end game being the PCEHR deployment.
Stop reguritating bad reporting and get your facts right before you start shooting of from the hip as usual. Dave knows all. Dave for PM...

Anonymous said...

Are you going to post my previous comments or are you now in the censorship business?

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

And just where did I say it was? Me - not someone else?

I just used a source to start a discussion

I did not shoot from any hip..


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

And other than these 2 above mine - were the others where you reveal the calibre of you enourmous intellect and firm grasp of polite expression.


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

Just so all commenters know - all comments are approved before being posted - to avoid providing links to Sextoys and such.

I don't sit breathless behind the computer waiting for comments so time to process will suit me and not the poster.

Sorry if that is not good enough for abusive freeloaders.


ps. and yes - go over the top and I will ignore the comment - good grammar and clear exposition of the point you wish to make - avoiding personal invective maximises the chance of publication.


Anonymous said...

So all that you effectively do is repost other articles with no analysis or understanding
As you say Heads should roll
Maybe yours

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

Anon Oct 12 2010 4.54.

Before you go on - have a look at what I wrote - assuming you have a reading age that handles big words.

I provided over 2 pages of commentary pointing out this NEHTA effort is a joke. Others seem to agree.

Can I most respectfully your hiding behind anonymity shows you to be pretty pathetic!


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

Oh and BTW this is the last anonymous abusive post I will let through on this topic!


Anonymous said...

I agree with Anon
If you are going to post other journalists articles it would be appropriate to check the facts before deciding to post.
More Anon

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

My final comment on this:

If you have a problem with what the journalist wrote get back to him.

That point was not the core of my comments. My point was that this so called implementation approach was a joke. Get it? If you disagree argue that it is not a joke and show your self to be even sillier than I imagined.

No further correspondence on the journalist's mistake will be posted.