Sunday, November 14, 2010

What Needs To Come From the Planned E-Health Summit? A Clear Way Forward Would be a Good Start!

A short while ago (October 28, 2010) Federal Health Minister Nicola Roxon announced there would be an e-Health Conference (or Summit) - Revolutionising Australia’s Health Care held in late November 2010.

In announcing the Summit she confirmed that she and Minister Conroy would be speaking she said that the e-Health Summit will take place on the 30 November and 1 December at the Melbourne Convention Exhibition Centre. Attendees are to be “the nation’s leading health experts, consumer groups and information technology specialists who will come together to discuss the technological revolution in the delivery of health care” The full press release is available on the Department of Health web site.

The stimulus for having the Summit is explained in the following two sentences from the release. “The Gillard Government is investing almost $470 million to introduce e-health across the health system – including the introduction of personally controlled electronic health records to be rolled out from July 2012,” and “This investment will build upon the $392 million committed to modernise the health system by providing Medicare rebates for online consultations across a range of specialties for the first time.”

I found it interesting that the release points out that three implementation sites have already been selected but that the Summit “will provide an important opportunity for cross-sector collaboration and discussion around the design, implementation and vision for future capabilities of the system.

Representatives from governments, industry, private and public sector health care organisations, clinicians and consumer groups will discuss how this innovative system will work into the future.”

In summary, with no apparent associated release of discussion documents, plans and detailed information, we are to have a collection of experts get together to work out what to do next. This is absurd in my view and made even more so when consider the timeframe involved in the calling of this gathering.

This needs to be contrasted with that happened a little over a decade ago when a similar ‘Health On-Line’ Summit was called. In November, 1999 the National Health Information Advisory Council released an initial version of Heath Online: Health Information Action Plan for Australia. This was a quite comprehensive 115 page draft plan for further consultation.

The Council then conducted a National Health Online Summit in August 2000 which resulted in 188 page Summary of Proceedings. It was this well informed and comprehensive meeting, and a range of supporting documents that ultimately led to initiation of the first national Shared EHR program which was termed HealthConnect. This plan envisaged a National Health Information Network for Australia. It is dated mid-2000.

This program was worked on with research, technical pilots, legal reports and so on but as the plan was firmed up Ministers Abbott and Hockey were apprised by bureaucrats that the costs of implementation would be in the billions of dollars and so what had been an actual project suddenly (in August 2005) became a “Change Management Plan”!

For this proposed Summit we have no clear plan - unless you include the Deloittes developed National E-Health Strategy of some two years ago which was agreed to but not funded by Health Ministers - and a set of political announcements on amounts to be spent with no information provided at any real depth as to just what is proposed and now it is to be achieved.

It seems clear to me the proposed Summit is a consultative ‘fig-leaf’ where some pre-developed concepts will be delivered to the unsuspecting delegates who will then be unable, in the time available, be able to provide the requisite quality of advice and where something dreamt up in a Canberra consulting office will be inflicted on an unwary public.

This approach to implementation of e-Health is utterly doomed to failure as have all centrally mandated and developed implementations of e-Health where there has not been comprehensive and responsive consultation of both the caring professions and the public.

At the very least we need to have the promise of the internet being realised with full video streaming and provision of interactive facilities for participation. Of course archive availability is just assumed!

What is required is that this Summit be the beginning of a conversation with relevant stakeholders and that this conversation addresses the yawning gaps we have in the leadership, governance, co-ordination, planning and implementation of e-Health. Both sides of politics seem the think ‘e-health’ is ‘a good thing’ but to date the evidence suggests neither appreciates the difficulty and complexities that await.

To see this Summit as anything other than a first step would be deeply unwise. There is a very long way to go to e-Health nirvana and a hastily organised two day Summit will not get us there. To answer the question posed in the article’s title we need to commence a process that leads to an agreed and funded plan. The Summit has to be a beginning and not an end.

Conference announcement link:

The comments made to a previous note on this topic make fun reading. See here:

What an unremitting and pathetically organised fiasco this all is!



Anonymous said...

What an excellent summary. Thank you.

Anonymous said...

Let's face it if the people driving this summit are the same people who have been responsible for making leading Australia into this ehealth mess then anyone with less than half a brain should be able to predict the outcome without too much trouble.

Anonymous said...

Selective invites!!!! I know some of the brightest brains in ehealth in OZ. Checking with them I find they have registered to attend but have heard diddly squatt from the organizers even though others they know have had an invite. A

Does anyone know what selection criteria are being used for selecting invitees?

Anonymous said...

David you said "What is required is that this Summit be the beginning of a conversation with relevant stakeholders".

Sounds good at first glance but let's think about that for a moment.

Relevant stakeholders! Mmmm. DOHA, NEHTA, Jurisdictions, Peak Bodies, Boards and CEOs of health organisations (like Hospitals, Divisions, Nursing Homes, Aged Care Centres, Health Departments, ...... haven't we been there before? Haven't there been numerous conversations with stakeholders? And to what avail?

WHO do YOU see are the relevant stakeholders who can deliver something pragmatic, balanced, and useful out of such a conversation?

You make these hand waving in-the-air statements just like everyone else but its the detail that gets neglected.

Let's have some detail - that's the hard part - hence - WHO do you see are the relevant stakeholders?

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

I see the stakeholders as being those you mention but crucially, in addition, actual working clinicians, developers as well as standards developers (the actual doers) etc.

In summary we need the grass roots users and developers to balance the professional e-health politicians who have been pretty clueless to date.

I also think academia and consultants have useful perspectives that should be in the mix.

Bottom line - you are right that the group who Government go to at present is too limited and often lack real expertise and understanding.


Anonymous said...

Not wishing to be difficult but drilling a bit deeper you will recall NEHTA put together an army of 'working ' clinicians' (as you describe them) called 'Clinical Leads' under Dr Haikerwal's leadership.

Isn't that what you are calling for?

Weren't they the right people to represent 'working clinicians'?

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

A move in the right direction - but I don't believe they are having enough influence - witness the frustration expressed by Dr Haikerwal in the MJA a month or so ago. Also we need consumers - but well informed ones - involved.