Tuesday, October 30, 2012

There Is Governance Management Chaos Loose With The NEHRS. What A Nonsensical Fiasco.

The following amazing diagram crossed my path the other day and I felt an urgent need to share.

This diagram is described as the PCEHR Governance Context and really makes alphabet soup sound like an understatement.

Click To Enlarge

The issue with all this is that it virtually guarantees decision making paralysis. Additionally it guarantees that absolutely no-one will ever be held accountable or responsible for anything.

There is a prize being offered - an opportunity to post a guest blog - for the person who can correctly say what each of these acronyms stand for. Many of them are clearly secret as no one seems to have heard of them except the members!

Imagine the hours that could be happily wasted and the frequent flyer points that could be accumulated attending all these!

Wanders off holding sore head in hands. What utter nonsense!

Last - while I have your attention - I hear rumours of all sorts of things happening at NEHTA. Stay tuned as they say.



Bernard Robertson-Dunn said...

1) If that is supposed to be an explanation of responsibilities, IMHO it fails miserable. There is no indication of who is responsible to whom for what. Those lines should have arrows showing the direction of accountability and responsibility.

2) The Deloittes National eHealth Strategy says:

National E-Health governance - has been strengthened through the establishment of the National e-Health and Information Principal Committee (NEHIPC). NEHIPC advises the Australian Health Ministers’ Advisory Committee (AHMAC) on E-Health and information strategies and facilitates collaboration between the Australian, State and Territory Governments to implement these strategies."

Apart from NEHIPC being absent from the diagram, Does AHMAC report to the Standing Committee on Health (SOCH)?

Considering SCOH only conducts inquiries into matters referred to it by the House of Representatives or a Minister of the Commonwealth Government (http://www.aph.gov.au/Parliamentary_Business/Committees/House_of_Representatives_Committees?url=haa/index.htm} what is it doing reporting to COAG - or is it advising COAG? And doesn't the Minister sit on COAG?

3) And getting back to the Deloittes eHealth strategy, if that was conducted for NEHIPC to advise AHMAC why has the strategy been so well and truly ignored?

4) And of course there is always the question, Who is responsible for Health outcomes? Policy development, by definition, is the identification of solutions to which resources can be applied. It's a decision to spend money. Who is responsible for identifying and defining health problems and will be held accountable for spending the money on the solutions?

That diagram certainly doesn't show the answer.

5) and if you really want to know, these are the acronyms in the policy development box.
COAG - Council of Australian Governments
SCOH - Standing Committee on Health and Ageing
AHMAC - Australian Health Ministers’ Advisory Committee
NEHIPC - National e-Health and Information Principal Committee (not shown, but is a subcommittee of AHMAC)
NHIPPC - National Health Information Standards and Statistics Committee
NHCIOF - National Health Chief Information Officers Forum
NHRF - National Health Information Regulatory Framework

Earl Hose said...

A case now before a Coroner illustrates an easy goal for NEHR. Why can't a national authority monitor the time taken from presentation at ED to first dose of antibiotic?

Is anyone able to comment?

Paul Fitzgerald said...

@Earl, I think one of the biggest issues in the scenario you raise is the fact that meds management and ED systems don't necessarily talk to each other - and of coursed, meds management is not widely used in acute care anyway. For the NEHRS to be useful, it has to be "fed" relevant information. That means all sectors of healthcare having systems that are interoperable and able to provide real-time information. Then we might get the much vaunted "continuum of care".

Earl Hose said...

Paul - the concept of continuum must involve relationships of trust. End users will define Trust, more often than not by perceptions about the whole world of comms, rather than by measurable entities in the health sphere.
For example, what are the obligations of citizens and what should concern us when we use our devices? On my tablet am I able to adjust the location services to suit my own needs? In my browser, am I able to choose settings for Cookies, and can I view the list of security certificates that have been accepted by the browser? That list of certificates is long and includes many national authorities, on trust.
Mobile phones are susceptible to viruses and malware, too, so it is worth knowing that most have no anti-virus protection.
It is not the place of governments to interpose protections at every level, nor is it even possible to do that when most of our security is in our own hands.
It will be interesting to watch users, clinicians & patients, form their impressions of the security & privacy of health informatics in a rapidly changing world of personal communications.

Paul Fitzgerald said...

@Trevor, agree entirely, and this will become even more important as the new Privacy rules come into play. Very large penalties for breaches - so clinicians using a mobile device (BYOD perhaps?) without proper security may face huge fines for breaches. Certainly food for thought as IT departments consider BYOD etc.

Earl Hose said...

Talk about deja vu! Have just turned up Rhonda Jolly's 'The e health revolution—easier said than done' at Parl'y Library.
Another that may be of interest is Brenton Holmes' 'e-voting: the promise and the practice' since there will be a lot of attention given to electronic voting in Ohio. Some (all?) of the US States with e-voting do not have any means of re-count. Could be nasty & throw another pall over citizens' assessments of trust in electronic transactions.

p said...

@Trevor, when I worked with IBM in the nineties, we used to take clients to the "E-Government" site in Washington DC - e-voting was the big thing that would revolutionise voting in the 2000's....well maybe eventually... :-)