This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
Quote Of The Year
Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"
or
H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."
Thursday, November 22, 2012
Recent Comments Seem To Be Working!
All,
Have found a new 'gadget'. Seems to work to display recent comments.
Yes, they are. Did anyone notice articles about resignation of CIO of AGIMO? Glancing down the prospectus for AGIMO, there would seem to be plenty of scope control over NEHTA-DoHA, eg, National Smartcard Framework. If a consumer had questions about the interaction between AGIMO and NEHTA, where would they go? Senators, MPs, journalists, IBM? By the way, is IBM headhunting top-flight government employees? Could there be miraculous "solutions" on the way from "the industry" to help DoHA "move forward" out of a tight spot with Health IT?
You need to understand the way the Australian Government works, via the Public Service Act (PSA) and the Financial Management Accountability (FMA) Act.
Briefly: Each minister is responsible for achieving the goals in their portfolio. A Departmental Secretary (of which there may be several in a portfolio) is responsible for delivering agreed outcomes. Ministers with central agencies, like PM&C, Treasury, Finance can only set goals (usually via budget allocations) and ensure that everyone meets the requirements of the law and regulations.
AGIMO is part of the Department of Finance and Deregulation. AGIMO has no power whatsoever over any department's initiatives, other than that must be legally conducted. especially with respect to procurement.
If you look at how AGIMO achieves its goals they are all done through procurement mechanisms. AGIMO can say "if you want to buy something, this is how you buy it". AGIMO cannot say "you must buy this, not that". AGIMO also cannot say "you should not have bought something or done something" whatever AGIMO might think about it, as long as it is legal.
Under the Australian Constitution, Ministers and their Departmental Secretaries are independent entities. Just about any collective or agreed initiatives are done via collaboration, not by fiat. Departmental Secretaries have a mechanism called Executive Orders that can over-ride just about any central agency directive other than those under the PSA and FMA. And even then they can sail close to the wind.
And that includes security. National security agencies such as the Attorney General and DSD may set standards, make risk assessments and make recommendations. It is up to the Departmental Secretary to judge the risk and decide if they want to accept it or not. AGIMO cannot over-ride these decisions.
In summary, to the best of my knowledge, AGIMO has had no input, and is prevented from having any input, into the decision making process of anything to do with eHealth.
About the only area where AGIMO could have had an impact is in which data centres DOHA can put its servers. And I think DOHA even messed that up, judging by the press reports on what they've had to do with their DR environment.
I always find it amazing that Australian Governments work as well as they do - given the constitution we've got.
Thanks, Bernard. Am still curious, though, and maybe will try to get a look at minutes from ICT Governance Committees. Perhaps a fax to Mr David Tune, PSM, the Secretary of the Department of Finance and Deregulation, will do the trick.
Text of fax sent today, also copied to an email. -- Dear Mr Tune I was employed in the Victorian public hospital system as pathologist from 1980 to 2006. In that time, mostly as medical microbiologist, I developed and maintained a keen interest in application of computerised technologies to health care. (My submission to Productivity Commission's study 'Impacts of Advances in Medical Technology in Australia' is at #16.) While retired from that field, I have been watching the progress toward the National Electronic Health Record with concern, making various low-level contributions to the ongoing discussions. In particular, as in the above Submission, I remain convinced that Australian Government must bring on high-level discussions around the need for Identity Management and the practicalities of a Unique National Identifier. AGIMO has published on both, hence my reason for writing to you. Is any information on the deliberations of the ICT Governance Committees available for public view? -- Will notify of any response.
"...the need for Identity Management and the practicalities of a Unique National Identifier."
Various governments have made a number of attempts to implement a unique national identifier. There was the Australia Card in 1985/6 and the Access Card in 2006/7. Both initiatives failed miserably.
Disclosure: I worked for KPMG who were appointed to do project assurance, I was responsible for assuring the system architecture.
FYI, assurance means asking the question "have you done what you said you would do?"
This contrasts with auditing which asks the question "have you complied with the law and national standards"
My opinion was that what they wanted to do wouldn't work (but I wasn't allowed to say that in any of the reports) and also they hadn't done what they said they would (which did go into reports, phrased in an appropriate language).
As it happened, the project ground to a halt while they tried to sort out the legislation and they fought the privacy people who didn't think it was being implemented very well - in simple terms, it hadn't been thought through. Then the Libs were defeated at the polls, the Labor party saw the way the wind was blowing and junked the whole thing.
There is general agreement in most quarters that an national ID system is a good idea. Unfortunately, as with the Australia Card, the Access Card (and, IMHO, the PCEHR) ID initiatives were/are all half baked.
The Australia Card and the Access Card were both mandatory, were badly managed and failed. IMHO, the only difference between the NEHRS and the earlier attempts are that the PCEHR is opt in and that it has cost a lot more.
If the PCEHR had been mandatory, I believe it would have met a lot more concerted and well organised resistance and would have failed a long time ago. As it is, it is largely under the radar as far as your average citizen is concerned, but will fail just the same, but more slowly and probably quietly, in a haze of euphemisms.
To get back to your point about a national ID system. If it were done properly, it has the potential for significant benefits. Even if it were just a replacement for the current Medicare Card, which is so far beyond its use-by date it isn't funny. It's costing the nation millions in welfare fraud. From what I read and hear, Centrelink seems to be doing its best but is hampered by the ribbon cutting politicians of the past.
Re your correspondence with Mr Tune. I predict you will get some pleasant words back, but nothing of substance. Every Canberra Politician and Bureaucrat knows that a national ID system is off the agenda, mainly because the electorate is highly suspicious of previous attempt. My guess (I have no knowledge, one way or the other, I just know Canberra) is that The result is that there are no realistic proposals being discussed - it's a waste of time.
IMHO the PCEHR hasn't helped, all it has done is re-enforce the electorate's view that government doesn't do these big projects very well. And they're right.
References Australia Card http://www.rogerclarke.com/DV/OzCard.html http://en.wikipedia.org/wiki/Australia_Card
Thanks, again, Bernard. I confess to being stuck in a time-warp, since Lynelle Brigg's July 2000 A Health Information Network for Australia. One the signatories to that report, Keith Kranz (then in Vic DHS), gave a presentation on 'Electronic (Virtual) Health Record' to the local branch of Australian College of Health Executives (re-badged as Australasian College of Health Service Management) in 2002 (archived pdf). The gotcha slide is the one on costs. Either of those would have stories about the NEHR, but I reckon the saga has chewed up many good people.
I have the same criticism of that report as I do of the PCEHR. There is no definition or analysis of the information which an VHR and the associated infrastructure is supposed to manage and process.
How anyone can create a solution to a problem so badly defined always amazes me. Unfortunately they do and the projects that try to implement such solutions usually fail.
I'll say it again. eHealth is about information, not technology or infrastructure.
7 comments:
Yes, they are.
Did anyone notice articles about resignation of CIO of AGIMO?
Glancing down the prospectus for AGIMO, there would seem to be plenty of scope control over NEHTA-DoHA, eg, National Smartcard Framework.
If a consumer had questions about the interaction between AGIMO and NEHTA, where would they go? Senators, MPs, journalists, IBM?
By the way, is IBM headhunting top-flight government employees? Could there be miraculous "solutions" on the way from "the industry" to help DoHA "move forward" out of a tight spot with Health IT?
@Trevor3130
You need to understand the way the Australian Government works, via the Public Service Act (PSA) and the Financial Management Accountability (FMA) Act.
Briefly: Each minister is responsible for achieving the goals in their portfolio. A Departmental Secretary (of which there may be several in a portfolio) is responsible for delivering agreed outcomes. Ministers with central agencies, like PM&C, Treasury, Finance can only set goals (usually via budget allocations) and ensure that everyone meets the requirements of the law and regulations.
AGIMO is part of the Department of Finance and Deregulation. AGIMO has no power whatsoever over any department's initiatives, other than that must be legally conducted. especially with respect to procurement.
If you look at how AGIMO achieves its goals they are all done through procurement mechanisms. AGIMO can say "if you want to buy something, this is how you buy it". AGIMO cannot say "you must buy this, not that". AGIMO also cannot say "you should not have bought something or done something" whatever AGIMO might think about it, as long as it is legal.
Under the Australian Constitution, Ministers and their Departmental Secretaries are independent entities. Just about any collective or agreed initiatives are done via collaboration, not by fiat. Departmental Secretaries have a mechanism called Executive Orders that can over-ride just about any central agency directive other than those under the PSA and FMA. And even then they can sail close to the wind.
And that includes security. National security agencies such as the Attorney General and DSD may set standards, make risk assessments and make recommendations. It is up to the Departmental Secretary to judge the risk and decide if they want to accept it or not. AGIMO cannot over-ride these decisions.
In summary, to the best of my knowledge, AGIMO has had no input, and is prevented from having any input, into the decision making process of anything to do with eHealth.
About the only area where AGIMO could have had an impact is in which data centres DOHA can put its servers. And I think DOHA even messed that up, judging by the press reports on what they've had to do with their DR environment.
I always find it amazing that Australian Governments work as well as they do - given the constitution we've got.
Thanks, Bernard.
Am still curious, though, and maybe will try to get a look at minutes from ICT Governance Committees. Perhaps a fax to Mr David Tune, PSM, the Secretary of the Department of Finance and Deregulation, will do the trick.
Text of fax sent today, also copied to an email.
--
Dear Mr Tune
I was employed in the Victorian public hospital system as pathologist from 1980 to 2006. In that time, mostly as medical microbiologist, I developed and maintained a keen interest in application of computerised technologies to health care. (My submission to Productivity Commission's study 'Impacts of Advances in Medical Technology in Australia' is at #16.)
While retired from that field, I have been watching the progress toward the National Electronic Health Record with concern, making various low-level contributions to the ongoing discussions. In particular, as in the above Submission, I remain convinced that Australian Government must bring on high-level discussions around the need for Identity Management and the practicalities of a Unique National Identifier. AGIMO has published on both, hence my reason for writing to you.
Is any information on the deliberations of the ICT Governance Committees available for public view?
--
Will notify of any response.
@Trevor3130
"...the need for Identity Management and the practicalities of a Unique National Identifier."
Various governments have made a number of attempts to implement a unique national identifier. There was the Australia Card in 1985/6 and the Access Card in 2006/7. Both initiatives failed miserably.
Disclosure: I worked for KPMG who were appointed to do project assurance, I was responsible for assuring the system architecture.
FYI, assurance means asking the question "have you done what you said you would do?"
This contrasts with auditing which asks the question "have you complied with the law and national standards"
My opinion was that what they wanted to do wouldn't work (but I wasn't allowed to say that in any of the reports) and also they hadn't done what they said they would (which did go into reports, phrased in an appropriate language).
As it happened, the project ground to a halt while they tried to sort out the legislation and they fought the privacy people who didn't think it was being implemented very well - in simple terms, it hadn't been thought through. Then the Libs were defeated at the polls, the Labor party saw the way the wind was blowing and junked the whole thing.
There is general agreement in most quarters that an national ID system is a good idea. Unfortunately, as with the Australia Card, the Access Card (and, IMHO, the PCEHR) ID initiatives were/are all half baked.
The Australia Card and the Access Card were both mandatory, were badly managed and failed. IMHO, the only difference between the NEHRS and the earlier attempts are that the PCEHR is opt in and that it has cost a lot more.
If the PCEHR had been mandatory, I believe it would have met a lot more concerted and well organised resistance and would have failed a long time ago. As it is, it is largely under the radar as far as your average citizen is concerned, but will fail just the same, but more slowly and probably quietly, in a haze of euphemisms.
To get back to your point about a national ID system. If it were done properly, it has the potential for significant benefits. Even if it were just a replacement for the current Medicare Card, which is so far beyond its use-by date it isn't funny. It's costing the nation millions in welfare fraud. From what I read and hear, Centrelink seems to be doing its best but is hampered by the ribbon cutting politicians of the past.
Re your correspondence with Mr Tune. I predict you will get some pleasant words back, but nothing of substance. Every Canberra Politician and Bureaucrat knows that a national ID system is off the agenda, mainly because the electorate is highly suspicious of previous attempt. My guess (I have no knowledge, one way or the other, I just know Canberra) is that The result is that there are no realistic proposals being discussed - it's a waste of time.
IMHO the PCEHR hasn't helped, all it has done is re-enforce the electorate's view that government doesn't do these big projects very well. And they're right.
References
Australia Card
http://www.rogerclarke.com/DV/OzCard.html
http://en.wikipedia.org/wiki/Australia_Card
Access Card
http://en.wikipedia.org/wiki/Health_and_social_services_access_card_%28Australia%29
http://www.privacy.org.au/Papers/AccessCard-070717.ppt
Comparisons
http://www.caslon.com.au/australiacardprofile.htm
http://www2.austlii.edu.au/~graham/publications/2006/ID_Card/OzCard_comparison.pdf
Thanks, again, Bernard. I confess to being stuck in a time-warp, since Lynelle Brigg's July 2000 A Health Information Network for Australia.
One the signatories to that report, Keith Kranz (then in Vic DHS), gave a presentation on 'Electronic (Virtual) Health Record' to the local branch of Australian College of Health Executives (re-badged as Australasian College of Health Service Management) in 2002 (archived pdf). The gotcha slide is the one on costs.
Either of those would have stories about the NEHR, but I reckon the saga has chewed up many good people.
@Trevor3130
Re the Keith Kranz presentation.
I have the same criticism of that report as I do of the PCEHR. There is no definition or analysis of the information which an VHR and the associated infrastructure is supposed to manage and process.
How anyone can create a solution to a problem so badly defined always amazes me. Unfortunately they do and the projects that try to implement such solutions usually fail.
I'll say it again. eHealth is about information, not technology or infrastructure.
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