Sunday, May 25, 2014

The PCEHR Review And NEHTA: How Many Times Have We Been Told This Continuing Disaster Needs To Be Fixed? It HAS To Be Fixed This Time!

As far as I can tell this is at least the fourth time highly paid consultants have insisted major changes and restructuring is required at NEHTA. It has still not happened for unknown reasons.
My view, for years, has been that NEHTA is part of the  of the problem rather than part of the solution.
We have this from the PCEHR Review:
2. Restructure the approach to governance, dissolve NEHTA and replace with the Australian Commission for Electronic Health (ACeH) reporting directly to the Standing Council on Health (SCoH). 

In the Review - (p20) on in the .pdf - there is strong evidentiary support for this recommendation.
In the PCEHR Review we are given the current Deloittes view.
To quote Deloittes in 2013 we have:
“Given the scale and complexity of the national eHealth work program, Australian Governments should continue to play a lead role in directing and coordinating national implementation activities. However, the move from a focus on nationally shared eHealth infrastructure to meaningful use of eHealth solutions by care providers and consumers, argues the case for a more broadly based involvement in the governance process – particularly extending to clinical and patient communities and private sector health operators.

Key to strengthening the current governance arrangements will be the establishment of an eHealth entity (created through the transformation of NEHTA) that is focused on coordinating execution of the national strategy and the nationally funded eHealth work program. To perform this role it will be necessary for the eHealth entity to have a Board made up of key parties beyond Government representatives (including strong care provider and consumer representation) and to oversight the building of close working relationships across the public and private health sectors and with the health IT vendor community.”
Deloitte : National e-Health Strategy for Australia November 2013
Next we have:
From Deloittes in the 2008 National E-Health Strategy (yes 2008!) we have (p6)
R-4     Develop a governance regime which allows strong coordination, visibility and oversight of national E-Health work program activities.

  1. Establish a national E-Health governing board that reports to AHMC, has an independent chair and has a breadth of cross sectoral stakeholder representation.
  2. Establish an independent national E-Health regulation function to implement and enforce national E-Health regulatory frameworks.
  3. Establish a national E-Health entity incorporating strategy, investment management, work program execution, standards development and compliance functions.
  4. Leverage NEHTA to establish the new entity and undertake a transition process to address changes to accountabilities, brand, culture, resources and operating model.

Page 66:

Impact on Existing Governance Arrangements

R4.4 Leverage NEHTA to establish the new entity and undertake a transition process to address changes to accountabilities, brand, culture, resources and operating model.
Impact on NEHTA
The establishment of a national E-Health Entity will directly impact the role of NEHTA. NEHTA, a collaborative enterprise owned by Australian, State and Territory Governments, was established to identify and jointly develop foundations for E-Health such as the definition of an agreed set of key national E-Health standards and specifications. This constitutes a subset of the functions proposed for the E-Health Entity. NEHTA’s organisational charter expires in June 2009 and hence there is an increasingly urgent need to address the future of the organisation.
In light of the proposal for the establishment of a national E-Health Entity with a significantly broader set of accountabilities and functions than NEHTA in its current form, there are three implementation options that have been considered:
1.       NEHTA to form the basis of the new E-Health Entity with a broader remit
2.       Establish a new legal E-Health Entity and integrate NEHTA’s current execution functions into its structure
3.       Establish a new legal E-Health Entity and allow NEHTA to operate as a separate organisation with accountability for the delivery of core E-Health foundations.
The first option is for NEHTA to form the organisational basis of the new E-Health Entity. This would require the existing NEHTA organisation to extend its accountabilities and functions to allow effective governance of the national E-Health Strategy and the execution of the national components of the three strategic work streams. This option would necessitate changes to NEHTA’s constitutional basis to extend the range of organisational responsibilities and to end the transitional nature of the authority. It would also require changes to the organisation’s brand and operating model.
The advantage of this approach is that the existing NEHTA organisation including legal structure, resources, capabilities, funding and governance arrangements, could be relatively quickly leveraged to support the establishment of the new E-Health Entity. One disadvantage is the extent of work required to restructure, refocus and reskill the organisation. The other is the need to overcome the historic and reasonably widespread perception in parts of the health sector that NEHTA’s progress to date has been too slow and not inclusive enough of the care provider community.
The second option is to establish a new legal E-Health Entity that would integrate NEHTA’s existing execution functions into its structure. The advantage of this option is the establishment of a new national E-Health Entity with a clear set of accountabilities and which is unencumbered by history. The key disadvantage is that the structure and constitutional and legal basis for this organisation must be designed and created from scratch which is likely to be a lengthy exercise and therefore could delay meaningful progress towards national E-Health outcomes.
The third option is to establish a new legal E-Health Entity and allow NEHTA to operate as a separate organisation with accountability for design and execution of national E-Health foundations. In this option, NEHTA would report in to, and seek strategic direction and funding from, the E-Health Entity. This option will minimise impacts to the existing NEHTA work program, but will also create delays associated with the establishment of the new entity. It will also create the significant potential for overlap, duplication and poor coordination between the two organisations, ultimately risking the coordinated delivery of national E-Health outcomes.
Specific Actions
Given the strong national consensus for action and the amount of E-Health activity occurring at a national, State and Territory, regional and local level around the country, there is the need to move quickly to establish an appropriate long term E-Health governance regime. A pragmatic option is to leverage the existing NEHTA organisation and legal structure as the basis for creating the new E-Health Entity. In NEHTA, Australia has created and invested in a vehicle for the progression of the national E-Health agenda and, whilst the journey to date has at times been problematic, it represents the best foundation upon which to build momentum behind a national E-Health work program.
This recommendation will require changes to NEHTA’s constitutional basis to extend the range of organisational responsibilities and to end the transitional nature of the authority. It should also involve changes to the organisation’s brand, culture and operating model and the creation of a revised operating structure supported by appropriately qualified leadership and specialist resources. 
In order to ensure there is a clear distinction between the new entity and NEHTA, there is a need for a formal transition process which should be completed over an estimated six to nine month time period. 
In late 2007 NEHTA was reviewed by the Boston Consulting Group.
They recommended (Here is the Table Of Contents):
Recommendation 1: Create A Culture Of Transparency And Outward Focus...............48
Recommendation 2: Reorient The Workplan To Deliver Tried And Tested Outputs.......50
Recommendation 3: Raise The Level Of Proactive Engagement Through Clinical And
Technical Leads.................................................................................................................54
Recommendation 4: Accelerate Resourcing Through Outsourcing, Offshore
Recruiting And More Creative Contractual Arrangements. ..........................................56
Recommendation 5: Reshape The Organisation Structure To Address Revised
Recommendation 6: Add A Number Of Independent Directors To The Nehta Board To Be
Broader Advocates Of Ehealth, And To Counter Stakeholder Perceptions Of Conflict
Of Interest. .......................................................................................................................60
All this is just to demonstrate how resistant NEHTA has been to culture change and improvement.
Since 2007 the problems of culture and the lack of transparency and appropriate governance have been obvious.
That all this has been not addressed over what has now been going on is a travesty. I know many who read here are just sick of how NEHTA behaves - witness the bulk resignation of all the clinical leads late last year.
If the recommendation to re-structure NEHTA is not followed we can all give up as no improvements are likely in our lifetimes!
For those who would like to read more, the older files can be found here:


Anonymous said...

There will never be any new substantial progress while the same people remain involved as they are incapable of bringing new thinking to the table. Their brains are wired one way and cannot be rewired. Therefore, the same brains working on the same problem will get the same result. Go forth and find new brains.

Anonymous said...

NEHTA is certainly a huge problem, but the cancer has spread to DOHA. They continually think they can solve problems and point to certain parts of the industry as the cause of the problem but they are clueless and generally have it all wrong.

They should practice governance by insisting on standards compliance where standards exist, and not try their hand at standards creation or implementation and stop picking winners or indicating they will punish one sector as do not have a clue what they are doing. For the Billion dollars of investment private vendors have been sidetracked on wild goose chases and real innovation and progress has been put on the back burner and we are going backwards.

Worldwide the money that has been wasted on government interferance without much progress must be enormous. The fiasco was predictable but we were fast followers of strategies that had failed. So silly, such a waste, and yet the Hubris remains... So much Hubris that they can't even tell when they have failed miserably.

This is an area where we need small government, the solutions are out there, but there is no way they are coming via DOHA or NEHTA. Dissolve away I say

Anonymous said...

It is incredible that NEHTA has survived this long and continues to survive in some form. The managers and exec within NEHTA have been adamant that there is NO transparency, that none of the employees were to discuss anything. There was an active process of elimination- all those who attempted to raise their voices against bad practice were shut down either by threats of litigation or just by being 'disciplined'.
It is not the 'worker bees' that are at fault in most cases. However,there are a lot of NEHTA employees in middle management who are equally as bad- some who have had nothing to their credit for about 5 years (they are still there!!). No one knows what they do- but what we know, is that they keep exec happy by not saying a thing. The whole place is surreal- there is no accountability, that the high pay that most of these people get, is tax payer funded. Senior management are flown in from the UK for their 'consultancy', test analysts given the opportunity to fly in and out from interstate.. And they are still hiring!!

Bernard Robertson-Dunn said...

IMHO, these approaches are fundamentally flawed. They are all about project management and implementation.

From the NEHTA website:

"Our purpose is to lead the uptake of eHealth systems of national significance and to coordinate the progression and adoption of eHealth by delivering urgently needed integration infrastructure and standards."

All about systems and infrastructure.

What's missing is the thinking that underpins such phrases as "national significance" and "urgently needed".

I can understand the argument about avoiding the old multiple rail gauges problem. What's not being talked about is the equivalent of "Do we need a railway? If so what sort and where should it go? If not, what do we need that's better?".