Wednesday, December 28, 2011

An Appendix To My Senate Submission With The Bare Bones Of A Possible New Direction.

I felt there was a need to say what I would like to see happen - after being critical of what has happened to date:
Here is a first DRAFT!

Appendix 1.

In this section I offer a series of suggestions which might be adopted to recover the present unsatisfactory situation.
Guiding Overall Objectives:
The 2 guiding overall objectives are:
1. To empower and enable clinicians to deliver better, evidence-based, co-ordinated, informed and planned care through information available at the point of care.
2. To enhance consumer engagement with their care through information provision and sharing - ideally via information resources available via their provider or via a Health Information Exchange Portal.
At a practical level it is crucial that an agreed, properly communicated National E-Health Strategy be at the core of what is done and that this Strategy is properly funded and resourced. The key activity of the proposed Federal Office would be to actually implement that national strategy using the resources provided.
Suggested Governance Approach.
I believe we need to establish a Federal Co-Ordinating Office for Health IT which is led by a CEO who reports to the Minister and who is fully accountable to the Minister and Public for making progress in the E-Health domain. (The US Office of the National Co-Ordinator for Health IT (ONC) seems to be a model that may be usefully carefully reviewed)
Objective of this office is to provide e-Health leadership and to co-ordinate and align all the diverse activities by working with all stakeholders. (Clinicians and Health Service Providers, Consumers, Vendors, Standards Bodies, State Jurisdictions and so on)
I would envisage a representative Board / Steering Committee (and probably a range of specialist sub-committees) to advise the CEO and Minister on all matters relevant to the deployment of Health IT in the Australian Health System at all levels.
A structure similar to the National Prescribing Service might be an appropriate model to consider. Alternatively the TGA might provide a model. No doubt some formal regulatory powers will be needed - especially in areas of safety and standards etc.
Given experience to date, both here and overseas, a permanent organisation of some scale has to be assumed to be necessary into the foreseeable future.
Guiding Principles:
1. Maximise reuse and deployment of all the useful work undertaken by NEHTA and its staff.
2. Maximise the use of NEHTA staff related to the areas of activity that are planned to continue.
3. Constructive engagement with the Health IT Vendor / Provider Community and the entire Healthcare Provider Community (Doctors, Nurses, Allied Care etc)
4. The proposed Office have a formal policy of openness and transparency with all, meetings documentation and policies being made available publicly - except where genuine commercial concerns would prevent such transparency - e.g. tender evaluation documents.
5. A strong bias to the use of competitive public processes for all procurements of goods and services.
6. Focus on proven technical approaches and architectures for applications, security, privacy etc.
7. Emphasis on improvements in health care outcomes, patient safety and facilitation of Health Care Reform.
8. The recognition of the need for continued substantial investment in the e-Health space while ensuring value for money is being obtained.
9. The use of evidence based approaches for the selection of programs and systems to be funded and implemented.
10. Continued investment in areas such as education to optimise implementation outcomes.
11. Transparent evaluation of all programs during and post implementation for beneficial consumer, clinician and or financial outcomes.
A Possible Implementation Strategy:
Step One would be a Checkpoint Strategic Review and confirmation of a modified version of the 2008 National E-Health Strategy as developed by Deloittes.
The implementation strategy I would envisage would be to establish appropriately sized Health Information Exchanges (HIE) in relevant areas - standards based so that they can later be linked - using the sensible practical components of NEHTA's work done thus far.
Over time the geographic coverage would increase and merge into what would become a National HIE.
This would be associated with improved GP, Specialist and Hospital Health IT deployments  and standards based linkage of all these systems to local Health Information Exchanges.
I believe such an approach would work incrementally and demonstrably as is happening in the US and to a degree in places like Singapore.
The approach is known to work and preliminary evidence is building indicating real benefits and cost savings.
Very useful links are found here:
Overall what this is, is a national distributed health information exchange which grows up organically and which the consumer accesses their information via a connection with their clinician based systems. This is now the way we see the UK going with better GP systems, better consumer connectivity and only what amounts to an emergency care record centrally. Think of the success being seen also in Scotland, Scandinavia and so on.
Advantages of the Suggested Approach.
This is a low risk, driven by the ground up approach that would is proven and would be safer and cheaper for all concerned. It would be less costly (but by no means cheap) bit and much of what NEHTA and DoHA have done could be re-used.
Overall is it much less big bang, much less risk, but still driving something forward, especially if you establish an Australian ONC and take other useful components of the of the Deloittes 2008 Report.
Unlike the PCEHR it is highly likely this suggested approach will work. This would be made even more likely if Australia chose a set of implementation and adoption incentives adapted for Australia from the $US 40 Billion ‘Meaningful Use’ program in the US.
Comments and ideas welcome!

1 comment:

Dr David More MB PhD FACHI said...

This is the comment flow with name links removed as I seem them as spam.



Cris Kerr, Case Health, Community Health Researcher & Advocate for the Value of Patient Testimony said...

David, I hope the content of my recent posts on 'TheConversation' will be of interest.

The posts are located here:

The posts are in response to the article; 'Lost about health-care reform? Here's where we got to in 2011'
Thursday, January 05, 2012 11:09:00 AM
Dr David More MB PhD FACHI said...


Sadly your link does not work (at the top of your post) and your post in The Conversation describes a PCEHR which I do not recognise as the one described by NEHTA and DoHA in the ConOps.

I don't think 'Patient Testimony' was a driver of the original design and I suspect there are much better ways to obtain and deploy such information.

Thursday, January 05, 2012 11:27:00 AM
Cris Kerr said...

Hi David,

Sorry David, here's the correct link to feedback/proposal:$FILE/Case%20Health%20submission.doc

Yes, you're correct, the proposal is not the one adopted by NHHRC, nor DoHA, nor NEHTA.

The proposal describes a higher level approach to public health reform that to-date has not been adopted.

This is the 'much better way' to obtain and deploy the information... providing everyone understands the importance of having an honourable overarching mission, and the need for comprehensive, reliable public health data sets from which we can obtain meaningful use.
Thursday, January 05, 2012 5:28:00 PM
Dr David More MB PhD FACHI said...


Re your proposal as per your submission I just do not agree - as I believe the building blocks to get even remotely close do simply not exist.

I also don't much like links embedded in people's names other than a genuinely personal web site - looks a lot like spam, link seeking and self publicity to me. I will consider what to do with this stream overnight.

Late Note: I have decided on a cleaned up post.

Thursday, January 05, 2012 5:40:00 PM