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"
H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."
Wednesday, March 29, 2006
A Government Mouthpiece
The whole day was sprinkled through with flavours of Web Services and its bigger brother Service Orientated Architectures (SOA). While the slides were colourful, what was not made clear is that Web Services and SOA are both still very much works in progress and still having much of their implementation complexity worked out. I think it is rather early in the 'hype cycle' to hitch Australia's e-health future to these, as yet, unproven technological approaches. Time will tell, but another false architectural start - like HealthConnect - would be a very bad thing.
The worst aspect of the day was a speech given by a DoHA representative who should have known better given his background. His argument was based on the premise that because it is not possible to work out how to distribute the benefits from Health IT between governments, consumers and providers each should fund their own infrastructure. This is facile in the extreme. It is well known that the majority of benefits flow to the payers (Government in our case) and consumers and that most of the costs are incurred by the providers. If there is not a policy response to this stark fact nothing will happen - as has largely been the case to-date.
The only reason any competent bureaucrat would assert otherwise has to be because they have been told there will be no money and they need to put the best spin possible on a sad situation.
It will be interesting when the NEHTA Benefits Realisation Project identifies the truth. I wonder where DoHA will hide then?
David
Sunday, March 26, 2006
An Australian e-Health Strategy – Why, What and What Could It Achieve?
The central issue in e-health as I see it is that Australia has not developed, articulated, discussed and agreed a National e-Health Strategy, which brings together all the work being undertaken around the country, assembles it into some sort of coherent whole and provides forward direction and leadership for all involved. In response to the apparent movement from NEHTA I want here to expand my arguments and suggest just what the National Strategy I am proposing may look like.
On the basis that we need the plan, what should it contain and what factors and constraints should it consider.
Before anything is done the first step is to ensure it makes sense to proceed with planning. This is done by developing a generalised Business Case for National e-Health implementation. If overseas experience is any guide this will confirm the need for action and a plan.
What is involved in doing a plan? The first thing the National Strategy needs is a current view of just what is going on everywhere, and what is working well and needs to be preserved and encouraged. Next, once we have worked out where we are we need to work out where we need to be. This will involve a lot of consultation with all interested stakeholders to develop a vision of future Health Service delivery and then ensure we can put in place the technology to make it work. Fortunately there has been a lot of work done on the desired future state of the Health System and this can be utilised to guide the planning of the supporting technology initiatives.
Out of the requirements and consultative process there should emerge a number of options reflecting the use of different technical approaches, different priorities, different levels of preparedness to invest and so on. These will ideally be worked up into three or four roadmaps and then a second consultative process with stakeholders and the public will choose the most appropriate. This roadmap will then be worked up, in detail, and all the implications for consumers, professionals and others, risks, costs and so on thought through.
At this point there will exist both a clear reason for action and agreement at a high level as to what direction should be taken.
What might an overall strategy look like. The objectives and mission are easy. What we want from technology is better co-ordination of care (only answer questions once, don’t fall between the system’s cracks etc), greater safety with relevant knowledge provided to carers at the point of care, greater efficiency of service delivery at all levels and ideally our own little personal health record that has all our health information securely stored so that when needed it can be made available to those who need it – our doctor, nurse or who ever.
What technologies and systems do we need? Essentially there are five.
First all our hospitals need clinically rich and administratively effective internal systems that enhance patient safety and operational efficiency. These you can buy off the shelf from a range of Australian and overseas vendors – (IBA, Cerner, etc). These need to be advanced systems that provide excellent care documentation and physician order entry with advanced decision support.
Second our GPs and Specialists need similarly effective systems which manage all aspects of our care electronically and can receive and transmit information (referrals, prescriptions, test requests etc) securely and safely. These can be obtained reasonably cheaply but ideal ones are still a little way off.
Thirdly we need service providers (Specialists, Laboratories, Radiological Practices, Pharmacists etc) to provide their product (i.e. reports etc) electronically. Systems to do all of this are available off the shelf.
Fourthly we need in place a secure set of message standards to allow the information to flow where it needs to go safely and privately. These exist in simple form and are improving quite quickly.
Lastly we need some Standards to ensure all information that flows can be properly and reliably linked to the individual it relates to and contains information in a form that can be properly actioned by the receiving system. These largely exist today
With some will, and a rational funding plan that pays those who create the information that is of benefit to those who get to use it, implementation need take no longer than three to four years. The Implementation Plan will need to adopt a simple, walk before you run, bottom up style but is eminently doable for reasonable cost given the potential benefits.
There will be some issues with integration with previous initiatives but there is nothing that is not doable in all this, other than the need to have a plan and the will and resources to execute it.
What could this achieve? The answer has not yet been fully worked out but if the experience overseas is any guide savings of 5-10% of the health budget and a considerable reduction in clinical errors of all sorts is well within our grasp. We should stop talking about it and get on with it!
(Please note - for the expert readers - this commentary is very high level and lacks detail - but I am convinced it is basically sound - comments welcome!)
David
Thursday, March 23, 2006
NEHTA and Benefits Realisation
There is only one fly in the ointment. No matter who is assessing benefits opportunities they need to be clear as to what strategic implementation plan it is they are assessing the benefits of!
One can only hope that very soon NEHTA takes us all into their confidence and lets us know just what this plan is and what it involves.
Only with that done, and a costing of the strategy planned developed, will the first step of my master plan for e-health be underway, i.e. the development of a national business case that can mobilise government and public support.
We will all be watching NEHTA closely over the next few weeks to see what comes.
David
Tuesday, March 21, 2006
The Slow Demise of Health-E-Link
Today we learned that the NSW HealthConnect Trial for NSW - the Health-E-Link project is coming apart for the most basic of reasons - the lack of proper involvement and consultation of healthcare providers and consumers.
It seems that NSW Health has been so keen to get the project operational they have altered NSW Health Information Privacy regulations - to the annoyance of many who are interested in the issue - and have also failed to sign up the local doctors before attempting to 'go live'.
This is very sad as the project has cost a lot of money and was probably the best resourced of all these so called 'trials'.
Again it seems the bureaucracy has not understood the basic tenets of the management of complex change.
The losers, as always, are the Australian public, who deserve a great deal better.
David
Saturday, March 18, 2006
Reaction to the NEHTA Standards Framework
Some were very positive hoping to see much improvement in the timeliness and responsiveness of the e-health standardisation process and looking forward to more input from the relevant interests and stakeholders.
One correspondent made the very useful suggestion that it would be very valuable if technology was used to facilitate standards development and to make the processes more transparent and clear. A suggestion I heartily endorse - pity it was not a specific action point in the framework.
Mostly, however, there seemed to be disappointment about the lack of specific clarity in the action plan and the funding plans. One correspondent repeatedly muttered - "just a marketing doco with no real content".
Amusingly there has been fun when another correspondent pointed out in the GP e-mail list that the spelling standard for the document was confused and rather US like (or may be mid-pacific) with the use of centre and center occurring. I wonder what language standard was intended
The total proof of all this will be, however, where e-health standards are in 12 months.
We will all watch with interest.
Cheers
David
Thursday, March 16, 2006
Australian Framework for e-Health Standards Development
The intent of the document is to explain how NEHTA is going to operate in the Standards space and what its relationship will be to Standards Australia.
I suspect this document will cause some consternation among a range of stakeholders as the general tone of the document is that when we work out what the Standards are to be and then compliance will be obtained via control of government procurement and funding in the e-Health space. Given the dominance of the various government entities in e-Health via the States and funding provided to GPs this approach could impose all sorts of unexpected compliance costs on what is at best still a nascent industry. For any standardization effort to succeed it must benefit all stakeholders in balanced ways and not favour one stakeholder group over another
It must be hoped the proposed E-Health Standards Forum is actually as its name implies - a Forum for the exchange of ideas - and not a convocation where pre-determined outcomes are announced.
It is good to see the document recognises the progressive withdrawal of Government funding to e-health standards activities and it is to be hoped this recognition will be followed by positive funding action. Ongoing "monitoring and assessment" of available resources does not suggest a strong commitment to major change!
It must be said the order and depth in which current Standards Development Organisations are reviewed is telling. The virtual dismissal of DICOM, the IHE inter-operation approaches and the ASTM Clinical Care Initiative are of note. Its also likely openEHR proponents will be disappointed with the lack of even a single mention directly - given their activity in the EHR space at the very least.
The action plan is also of some interest in that all of these issues ought, in my view, have been sorted out ages ago. The relationship between NEHTA and SA has been disconcertingly vague for at least a year. It seems likely to be resolved, at the earliest, later this year. The other plans are relatively low impact if they are the whole 2006 agenda and a great deal more than this could be desired.
One is also left wondering just what are the full scope of the e-health standards to be addressed. This document should have contained a detailed listing as an Appendix at least - given such work is readily adaptable from the work done by Infoway in Canada and the US CHI Initiative.
Lastly - the value and utility of the document is greatly diminished by not being placed in the context of a published National e-Health Strategy and Plan. Without this overaching document it is hard to know what value is being delivered by the present document other than a collection of relatively warm motherhood statements and a very underwhelming and underpowered action plan.
David
Tuesday, March 14, 2006
Why do we Need E-Health?
Two major ideas have struck me.
Firstly it seems that the continuing rise in spending on Healthcare in general is becoming un-sustainable. In the US it is now thought it will reach 20% of the Gross Domestic Product (GDP) by 2015 (As identified in the US Health Policy magazine Health Affairs 2 weeks ago) and despite the best efforts of Mr Abbott and Mr Costello we look like reaching 15% of GDP in a similar time frame - despite the cost control mechanisms of the PBS etc.
Secondly it seems to me the Knowledge Management task now required of physicians is also becoming un-sustainable and it increasingly needs the support of information technology.
IT is good at helping with improving efficiency, managing and communicating information and identifying variations from the norm.
We need all this to allow us to see an improving health system and not one that fails under its own weight.
What do you think are the major drivers for better use of IT in the Health Sector?
David
Monday, March 13, 2006
Further Comment on the EHRVA Roadmap
The key conclusion of relevance to Australia is that it shows that there are a number of ways of "skinning the cat". With this clear there is a very serious implication.
This is that the National e-Health Strategy should be contestable and should be developed in a way that all reasonable options are carefully considered. There is nothing in the Roadmap that is totally "out of court" for adoption in Australia and I believe we should expect NEHTA to provide a clear statement of their roadmap and then let the contest of ideas operate to sort out the best way forward.
The previous HealthConnect strategy would appear to have been abandoned (after 5+ years of effort) but that is no justification for not putting all the reasonable choices on the table and having a carefully considered review.
I doubt this will happen but it would be good for all concerned if it did.
David