We Are Having A Rather Time Dilated ‘Year of Delivery’ from NEHTA.

NEHTA have just released their 2009/10 Annual Report.

It may be downloaded from here:

http://www.nehta.gov.au/component/docman/doc_download/1168-nehta-annual-report-2009-2010

The main theme of the Annual Report seems to be that last year we had the ‘Year of Delivery’

This term first came to my attention before the financial reporting period started as you will see from this link.

Wednesday, March 04, 2009

http://aushealthit.blogspot.com/2009/03/nehtas-year-of-delivery-morphs-into.html

and the major delivery - the commencement, but no use of the Health Identifier Service actually happened July 1, 2010 - so after the end of the reporting period.

Forget the nit-picking - cut it anyway you like things are moving a bit more slowly than we all may like.

In March 2009 we were told would have the following by the end of 2009 this.

“By December, the National E-Health Transition Authority (NEHTA) plans to have two pilot projects underway to test the usefulness of the e-pathology, e-prescribing and referral and discharge components of individual e-health records.” (see link above)

I am not actually sure almost a year late we actually still have these outcomes. I certainly have not seen the results of the pilots.

Anyway to the report. Overall it is the usual glossy and vague, detail lacking effort but there are some amusing nuggets.

First there is the good, in that there does seem to have been an evolution of the way NEHTA is managing project delivery - and this can only be a very good thing.

This is covered on Page 8:

Internal Governance at NEHTA

In order to better coordinate the complexities associated with achieving integrated health outcomes, NEHTA has established program boards for Solutions Development, Collaborations and National Infrastructure Services which provide delivery governance over the work program. The program boards are supported by the Project Management Office (PMO) to ensure coordinated governance arrangements and progression towards best practice approaches.

NEHTA has also established project boards to govern the delivery of specific project outputs required by each of the programs in line with PRINCE2 methodology that was adopted by NEHTA in 2009.

NEHTA continues its risk and issues governance through the Risk and Issues Management Team. This group, acting on behalf of the full Management Review Group, meets regularly to review risks of a strategic nature and ensures that mitigation plans are appropriate and being actioned.

---- End Extract

Three to four years too late but better late than never.

I found these paragraphs a bit worrying:

“The HI Service operates in conjunction with a standardised authentication infrastructure and complies with international best practice for information security.

It is acknowledged that software vendors will play a vital role in the implementation of the HI Service and the broader national e-health strategy. They will provide the interface between the HI Service and healthcare providers. NEHTA is committed to addressing vendor needs at each stage of the vendor journey:

• Probity—no business will be given favourable consideration
• Clarity—briefings will be aligned with HI Service releases to provide software vendors with clear guidance on regulatory and best-practice security and privacy requirements to underpin their product development
• Flexibility—product development can be staged to match each jurisdiction’s e-health timetable. The HI Service operates in conjunction with a standardised authentication infrastructure and complies with international best practice for information security.”

---- End Extract (Page 10)

I would have assumed all that goes without saying!

The bad is still that the overall governance of the e-Health project is still divided between DoHA, NEHTA, the CIOs and Industry in ways that are frankly dysfunctional.

Another bad is that there is still not a single recognisable expert on e-Health on the Board. Just how that can continue to be defies explanation in my view.

On page 30 we find a bit of oddness:

Employee survey

Sixty-eight percent of employees completed the annual employee engagement survey. The survey focused on a number of key areas:

• Vision and Strategy
• Leadership
• Business Processes
• Culture and Behaviour
• Communications
• Change

Key themes were communicated to NEHTA staff and action plans to address areas for improvement have been formulated.

Values

Survey feedback indicated interest in developing specific NEHTA values and behaviours. Workshops were conducted with both managers and staff with NEHTA values being agreed as:

• Accountability
• Integrity
• Collaboration
• Nurturing

NEHTA has continued to work with these four values by developing behaviours that will underpin the values, which will be included as an integral part of the 2010–11 performance and development review process for the first time, linking behaviours to performance.

---- End Extract

Why not all completing the survey and we would all like to see the accountability lead to attendance at Senate Estimates etc.

Anyway the most serious fact that emerges is that NEHTA is now costing over to $100 million per annum (100,341,347cash flow on people and supplies) and even allowing for a slight surplus this is still $274,900 per day being spent on this. (Note this is up from a bit less than $70 million last year)

The value for money for this expense is pretty hard to see right now from where I sit and for a ‘year of delivery’ there seems to be a lot of behind the scenes work that better provide some real outcomes pretty soon!

The permanent head count is now over 200 (to say nothing of contractors) and consultants are costing over $43 million a year (I wonder is part of that the cost of the HI Service? - it is not made clear)

What is also interesting is that the NSW and Qld Directors General of Health are not really interested attending only six of 11 possible Board Meetings.

Last point is that the NEHTA senior staff are not working for peanuts. The top nine employees (CEO, CFO, all those PR people etc.) drew an average of over $290,000 each in salary and super for the year!

Overall my feeling is that this whole report would fall into the ‘needs to try much harder and do much better’ category and that is from the Board Members down!

If we are not seeing real implementations and real clinical benefits by the time of the next Annual Report I reckon it’s time to try a different approach as it will be clear the NEHTA experiment is a failure.

David.