Sunday, October 11, 2015

The Dreaded Late Friday Afternoon Press Release From Government. Were We Meant To Miss It?

This appeared in my e-mail late on Friday.

Developing a 21st century electronic health record system

Minister for Health Sussan Ley thas announced the Committee that will oversee the rebooted personalised My Health Record system for patients and doctors.
Page last updated: 09 October 2015
9 October 2015
Minister for Health Sussan Ley today announced the Committee that will oversee the rebooted personalised My Health Record system for patients and doctors as part of a $485 million package to deliver Australians an electronic medical record system.
Ms Ley announced the appointment of Ms Robyn Kruk AM as the independent chair of the eHealth Implementation Taskforce Steering Committee responsible for the establishment of the Australian Commission for eHealth.
“A functioning national electronic medical records system is essential to ensure doctors, nurses, pharmacists and other healthcare providers across the country had instant access to the information needed to treat patients safely and efficiently without having to gamble on unknowns in their medical history,” Ms Ley said.
“As patients, we’ve all been in the situations where we’ve had to attend another GP surgery because we were out-of-town or couldn’t get an appointment with our regular doctor. It can be a time consuming and often frustrating experience for patients and doctors alike.”
In the 2015-16 Budget, the Coalition Government announced $485 million for the redevelopment of the My Health Record system to strengthen and transform national digital health governance through an Australian Commission for eHealth.
Ms Ley said the Implementation Taskforce Steering Committee brings together clinicians, public and private healthcare service providers, consumers, health informatics and analytics specialists, technology innovators and people experienced in delivery of digital health services.
Ms Kruk will be assisted by the skills and expertise of Dr Steve Hambleton, Dr Ewen McPhee, Dr Chris Pearce, Mr Richard Royle, Dr Eileen Doyle, Ms Jan Donovan, Mr Peter Cooper, Mr Mike Walsh, Mr Stephen Moo and Mr Paul Madden.
“In this modern world where technology makes information sharing boundless, it is essential Australia has a national digital health system and My Health Record makes up an important part of this system,” Ms Ley said.
“Ms Kruk has held several significant public service positions at the state and federal government level in health and environment, most recently, as chief executive of the National Mental Health Commission.
“The implementation taskforce steering committee will design, implement and oversee the transition of functions and resources from the Department of Health and the National e-Health Transition Authority to the Australian Commission for eHealth.
“The Australian Commission for eHealth will simplify and streamline the current governance arrangements and will ensure better accountability, greater transparency and improve stakeholder engagement throughout.”
The Australian Commission for eHealth will also oversee the operation and evolution of national electronic health systems and will be the system operator of the My Health Record System.
Ms Ley said next year, the Government will conduct trials of different participation arrangements for My Health Record, including opt-out, to identify the best approaches for increasing participation in the national digital health system.
“It’s important that all Australians are signed up to ensure we have a functioning system and trialling an opt-out model means we can do it carefully, methodically and ensure the appropriate protections are in place to give patients peace of mind,” Ms Ley said.
“If automatic registration for a digital health record in the opt-out trials leads to higher participation in the My Health Record system, the Government will consider adopting opt-out on a national scale.”
The Health Legislation Amendment (eHealth) Bill 2015 was introduced to Parliament recently and includes the allowance of opt-out trials of the My Health Record system to be conducted.
Members of the Implementation Taskforce Steering Committee are:
Ms Robyn Kruk,
Independent Chair
Dr Steve Hambleton
Dr Ewen McPhee
Dr Chris Pearce
Health Informatician
Mr Richard Royle
Private Health Sector
Dr Eileen Doyle
Governance and organisational design
Ms Jan Donovan
Consumer matters
Mr Peter Cooper
Information Technology and Innovation
Mr Michael Walsh
Australian Health Ministers Advisory Council
Mr Stephen Moo
Australian Health Ministers Advisory Council
Mr Paul Madden
The release is found here:
I spotted on article on the issue.

Ex-CIOs appointed to Australian e-health records committee

Madden, Walsh to ovesee My Health Record 'reboot'.

Former health CIOs Paul Madden and Michael Walsh will join fellow electronic health experts on the 11- person steering committee charged with guiding the revised implementation of personal electronic health records in Australia.
Health Minister Sussan Ley today named the inaugural members of the eHealth implementation taskforce steering committee, which will be chaired by chief executive of the National Mental Health Commission Robyn Kruk.
Paul Madden was until recently the CIO of the federal Department of Health, and has been at the forefront of the push for personally controlled electronic health records since the program was originally funded in 2010.
He recently took on a new role as special adviser in the department’s ehealth division.
Michael Walsh was the inaugural chief of the NSW government’s eHealth division, and defacto NSW Health CIO. He has since moved back to the Queensland government to take over the top job at Queensland Health.
Lots more here:
Just a few points on this release and commentary.
1. Why no official Terms of Reference for the eHealth Implementation Taskforce Steering Committee and why no documented reporting structure? Is this committee reporting to the Minister, Health Ministers or COAG and  what is the budget, what staff does is have and who do they work for and when is it meant to finish its work and when will ‘real’ ACeH start?  Will the Committee be issuing minutes and discussion papers etc.?
2. The Committee seems to have 11 members and only one who could reasonably be described as an e-Health expert. On the other hand it has a number of members who would struggle to be at all objective on just what should happen to the PCEHR and NEHTA- having already written a report to Government recommending NEHTA be abolished and the PCEHR be persisted with. They are hardly suddenly going to change their mind!

3. It is also important to note that we are not told the expectations for the actual ACeH in terms of staff, functions, Board, CEO, governance and so on. An early task of the new Committee needs to be to consult on just what the ACeH will look like - BEFORE it starts establishing it! Carts and horses as they say!
4. The dissolution of NEHTA is a very complex matter - what is, for example, going to happen to those zillions of pages of ‘specifications’ that have largely been ignored etc.? NEHTA has a range of function and simply decapitating it and then just having all the limbs flail around is hardly the answer. There are no recommendations on what goes, what stays and what changes I have seen and these will be crucial decisions. Does the ACeH decide later, the Minister or this new Committee sooner? We have not been told or consulted.
For the sake of everyone involved, (industry, clinicians and patients) we need some prompt revelations of more detail as to what is planned. This can be a real turning point if properly handled!
I wait in breathless anticipation but would bet it will just be business as usual with the same old secrecy and ineptness.


Anonymous said...

[discussing the PCEHR that has 500 document views a month, but no doctors, nurses, or patients using it]
James Hacker: You think it's functioning now?
Mrs. Rogers: Minister, it's one of the best run IT systems in the country. It's up for the Dilbert Award.
James Hacker: And what, pray, is that?
Mrs. Rogers: It's won by the most responsive IT systems in the area.

johnd said...

Looks like the steering committee you create when you don't want them to actually be steering.
Is this window dressing for some other agenda? It certainly looks like the members generally have no real background and ability to perform the unstated functions of this committee.

Anonymous said...

I can see three medical practitioners on the committee - Hambleton, McPhee and Pearce. I would expect each of them to use the PCEHR to its fullest extent right from the get go. Particularly so for Dr Hambleton who ever so vociferously advocated for its use by us and our patients when he was Chair of NEHTA. So too did Murkesh Haikerwal when he was clinical lead for NEHTA until he spat the dummy when he realised the PCEHR was a flop.

Anonymous said...

Stephen Moo has little room to move other than too replace his NT system with ACeH's rebranded version of the PCEHR.

Anonymous said...

Why no official Terms of Reference for the eHealth Implementation Taskforce Steering Committee? They will probably write their own Terms of Reference for the Government to sign-off.

Why no documented reporting structure? Is this committee reporting to the Minister, Health Ministers or COAG?

Certainly not the Minister. She's not that naive. Having almost divested herself of responsibility for this cactus under her saddle there is no way she wants to do anything other than keep distancing herself further from it. She only has to look overseas to see the pain experienced by government's eager to interfere in an area where free market forces should be allowed to prevail.

And certainly not the State Health Ministers who withdrew their funding of NEHTA some time ago; most of them won't want to get sucked back in to that fiscal vortex again - will they?

Anonymous said...

The Minister made it very clear that this Steering Committee's role is to:
1. design
2. implement
3. oversee
..... the transfer of functions and resources from the Department and NeHTA to the ACeH.

So, distance those responsible for what happened in the past, give them new jobs in a new entity, put everything into one new melting pot, and breathe a sigh of relief - problem now fixed.

Anonymous said...

The Minister made it very clear that this Steering Committee's role is to:
1. design
2. implement
3. oversee
..... the transfer of functions and resources from the Department and NeHTA to the ACeH.

but not re-design, re-implement or improve the PCEHR, just rename it.

If you are a believer in eHealth, there's probably only one thing worse than not being on the ACeH - being on it.

Terry Hannan said...

From Chile, the posted comments remind me of the plenary talk at AMIA by Dr Mark Smith of the Californian Health Care Foundation (non-profit). The Hype, The Hope and How to Avoid The Road to Hell.
Is what we are seeing meeting his points of view.
I like David's comments on there being at least one health informatician on the committee.
I am seeing first hand here in Chile what can be achieved within 3-5 years with ~US$25m when the eHealth project(s) are PATIENT CENTRED and the CLINICIANS (docs/nurses/pharmacists/allied health and HIT) get TOGETHER and work hard at it.

Anonymous said...

More than half this Committee spent years overseeing the current PCEHR debacle, working as senior decision makers for the Commonwealth, Northern Territory, various states and as NeHTA clinical leads. Dr Hambleton is on record as saying what a great job NeHTA did with it.

A fitting end to Mental Health week - announce we are putting the inmates in charge of building the new asylum and continue to do the same again, confidently expecting a different outcome.

Anonymous said...

On the question of what to do with Nehtas existing work... There is little of value there, so I think purging it would do us all a favour. If this project was the baby of any private entity it would have been shut down a long time ago. Resorting to opt out and ePIP to try and make it work is an admission of failure. Their most important job is to make it clear where we can go to opt out!!!

Richard Lea said...

Whatever this does, I hope they will consider incorporating some of the data sets that the NHS have used in their site:

It now links the GP, hospital and ambulance service and flags patients for whom acute care hospital may be inappropriate (eg palliative care patients). Ambulance staff are able to initiate treatments pre-ordered by the GP including strong opioids, without having to bring the patient to hospital.

Bernard Robertson-Dunn said...

Co-ordinate my care plan has very little in common with the PCEHR.

For a start it is highly focused. It does not contain a complete health record, only instructions and information relating to care, usually in exceptional circumstances.

Second, it exists to support specific health care processes.

Third, it has obvious benefits and value for a subgroup of patients.

Fourth, every user has a unique user-id and password.

Fifth, issues of data accuracy, consistency, relationships between patient and carers are precisely defined.

You might be able to shoe-horn some of the functionality into the PCEHR but the downsides of the PCEHR would probably overwhelm any benefits.

Have a look at their team
I can't see a public (or civil) servant among them.

Anonymous said...

On the question of what to do with Nehtas existing work... There is little of value there, so I think purging it would do us all a favour.

Fully agree, the Toolkits, CDA Specification, conformance material is painful, they contradict each other, even with the same product family, there has been one effort to maintain them or keep up with Standards as the are published or as stated by NEHTA. Perhaps NEHTA and soon to be ACeH should hand over clinical informatics to another body, it is clear NEHTA lacks the expertise or management skills to oversee the Clinical documents. I am sure they see FHIR as the answer, but I see no evidence NEHTA has the ability to be disciplined enough and we will see a repeat of the CDA specification sham.

Grahame Grieve said...

hi Anonymous @ 8:25 AM

It's certainly true that the outputs from the clinical document program are not beyond criticism, in spite of our hard work on them. But perhaps you'd care to drill further into this. Why has this happened?

If - as you imply - it's entirely due to mismanagement, then changing the manager might be expected to bring about an improvement to the situation. Or perhaps it is entirely due to the technology, and changing to FHIR would be the answer by itself.

Or perhaps, there are many factors, and there's no simple solutions; there's a set of things that could be done better, now that we've learnt what we've learnt, and it's actually possible that the community as a whole will learn from them and do better (Perhaps you could make constructive non-anonymous suggestions...?)