And Even Smaller Countries are Doing It! – e-Health Planning I Mean!

Just a very short post for the collectors of National E-Health Strategies.

The document is one of a series produced by the Intelligent Nation 2015 in Singapore.

The overall project context is described as follows

“In less than ten years, every single person and business in Singapore will find the world - and everyday life - transformed by technology.

iN2015 is the blueprint to navigate Singapore’s exhilarating transition into a global city, universally recognised as an enviable synthesis of technology, infrastructure, enterprise and manpower.

It is a living plan that gives every individual and endeavour seamless access to intelligent technology - and with it - the capability to take charge.

It is the new freedom to connect, innovate, personalise and create.

Intelligent Nation 2015 (iN2015) is Singapore’s 10-year masterplan to help us realise the potential of infocomm over the next decade. Led by the Infocomm Development Authority of Singapore (IDA), iN2015 is a multi-agency effort that is the result of private, public and people sector co-creation.

From the people sector, individuals provided their ideas and views through focus groups and the Express iT! iN2015 Competition. The competition attracted thousands of entries from students and the general public on how they envisioned infocomm would impact the way they live, work, learn and play in 2015. In addition, hundreds of private and public sector representatives participated in numerous discussions to come up with ideas for transforming their sectors through infocomm, and how to translate these ideas into reality.”

A full collection of the reports can be found at the

http://www.in2015.sg/reports.html

This document was published in June 2006. The URL to directly download the report (44 pages) is as follows:

http://www.in2015.sg/download_file.jsp?file=pdf/06_Healthcare_and_Biomedical_Sciences.pdf

It is quite fascinating to see the commonality of issues being faced in each of these reports and the similarity of the overall strategic direction that is targeted. Of specific interest in this report was the clinical focus – which seems to have been driven by the number of clinicians and health sector managers involved in the plan’s development.

Enjoy!

David.

Vale Dr Branko Cesnik - An Australian e-Health Pioneer

Klaus Veil has provided the following tribute to his colleague and friend.

-----

It was a sad day for Health Informatics in Australia, the region and the world.

Last Sunday afternoon, Dr Branko Cesnik passed away peacefully at his home in Melbourne

For many years, Branko was the hub of Health Informatics education and research at Monash University. He set up the then Centre for Medical Informatics (CMI) which became a renown facility for post-graduate health informatics distance education.

Branko served as president of the Asia Pacific Association for Medical Informatics (APAMI - he was one of the founders) and the Australian College of Health Informatics (ACHI) as well as a vice-president of the International Medical Informatics Association (IMIA).

Branko substantially contributed to e-health policy and strategy in Australia through participation in the National Health and Medical Research Council (NHMRC), the National Health Information Group (NHIG) and the Australian Health Information Council (AHIC)

Both the University of New South Wales and Monash University awarded Dr Cesnik honorary Associate Professorships.

I first worked with Branko well over 10 years ago when I was CIO of a large healthcare organisation in Sydney and was always impressed by his independent mind and clear view of matters. Because of his enthusiasm for accelerated use of IT in medicine our paths crossed many times professionally as well as personally.

Doctors who worked with Branko fondly recall the pleasure of exchanging, bouncing and debating ideas and advice with Branko as he worked at both Monash University and as an emergency medicine doctor at hospitals in Melbourne.

Academic colleagues valued his innovative and bi-partisan approach that reflected both his clinical experience and academic focus which were always evident. Branko's awareness of the utilitarian needs across health IT issues made him a significant contributor to the process of moving towards standards such as HL7 and some of the more innovative options that appeared over the last decade.

Others are speculating that St Peter will by now have been drawn into a detailed debate on the value of data standards in Heaven, maybe over a nice red...

Despite his progressing illness, in October last year the Board of HL7 Australia had the privilege to again experience Branko's skilful facilitation and sound strategic advice at our Board Day in Melbourne.

Branko leaves us a wonderful legacy of enthusiastic practitioners of IT in healthcare and thoughtful questioners of the 'status quo' that hopefully will persist until his visions are fulfilled. In the short time since the news of his passing, messages have poured in from the USA, Brazil, Hong Kong, Germany, Japan, Singapore, Malaysia, etc. all sharing our dismay and grief at this great loss to our international community.

On behalf of the health informatics community, I would like to acknowledge Branko's outstanding contribution to progressing health informatics in Australia and worldwide. Heartfelt condolences go to his wife Wendy and his two daughters.

Branko, you will be missed.

Klaus Veil

HL7 Australia

Funeral Arrangements

The funeral will be held Thursday 14th June, 10.30, at WD Rose Funerals, Burwood Chapel, 339 Warrigal Road, BURWOOD 3125, Victoria (Melway: p60 H6)

-----

I share all the sentiments and also wish to pass on my personal condolences.

David.

Oh Canada – A Good One!

This is almost too much. Two invaluable documents in two days!

The second is entitled 2015: Advancing Canada's Next Generation of Health Care.

The document can be downloaded from the following URL:

http://www.infoway-inforoute.ca/en/pdf/Vision_2015_Advancing_Canadas_next_generation_of_healthcare.pdf

On the main Infoway Web Site (http://www.infoway-inforoute.ca/en/home/home.aspx) it is described as follows:

“A Vision for Health Care in Canada

Consulting with leaders in all areas of the Canadian healthcare sector, Canada Health Infoway has developed a comprehensive strategy -- a vision -- for the next ten years of investment in healthcare information systems. The full report, 2015: Advancing Canada's Next Generation of Health Care, serves as a roadmap for modernizing Canada's healthcare system and forms the strategic framework to guide Infoway's investments and priorities for the years ahead.”

What points should be made about this refreshingly brief (36 pages) and well structured strategic document.

First it really should be read closely for all interested in e-health in Canada not only for its useful assessment of how Canada has gone forward but for the number of lessons and parallels it provides to the Australian situation.

Second the analysis of the issues facing Health Service Delivery in Canada really read like a “Guidebook to the Town of My Birth” in the clarity and accuracy they provided.

It is hard to argue with the following:

“In the future, the need to coordinate and manage information will become more crucial as:

• Patient consumerism continues to raise demand for transparency and timely delivery of health care, more self-care options, and alternative service delivery options (e.g., tailoredsolutions 24/7 at convenient locations, such as in the home).
• Canada’s aging population and Canadians’ health status drive an increased incidence of chronic diseases (e.g., diabetes) and an increased need for ongoing cancer care. By their nature, these types of conditions require managing a patient through many different care settings for extended periods of time, rather than just through “traditional” acute care interventions.
• The shortage of general practitioners creates a more sporadic pattern of care across multiple channels (e.g., walk-in clinics, acute care emergency settings, specialists) in which the system can no longer rely on the GP as a single point of integration to generate and manage a holistic view of the patient over time.
• Care settings continue to shift from acute to home care and other alternatives, particularly for more complex and information dependent treatment decisions such as chronic disease management. This will require further coordination across centres that traditionally lack information technology capabilities and the ability to request support as well as review the quality of care delivered.
• The rising costs of health care and continued funding and human resources constraints demand significantly higher levels of performance management by the system to drive improvement and to ensure its sustainability.”

It is also impossible to disagree with the barriers to better e-health identified.

“However, they have expressed concerns about a number of barriers that need to be overcome to

achieve the vision and realize the full value of the health infostructure. These barriers are:

• Inconsistent and sometimes insufficient commitments over time by federal and some provincial jurisdictions to fund the completion of the health infostructure

• The lack of a truly compelling “story” (for politicians, physicians, and the public) about the urgent and crucial need to build the health infostructure

• The inability to fully illustrate the impact (although all believe the benefits are there) and provide proven case studies

• The challenges of driving implementation and user uptake, including redesigning basic processes to unlock the full value of the system investment and providing the resources to ensure successful implementation and change management.”

It is quite clear from the body of the report that progress has not been quite as quick as may have been desired and that while real progress has been made there has been inconsistent levels of progress between different provinces (remind you of anywhere?)

Third the report is clearly, at least in part, a document to try and free up additional and very substantial funds to ‘finish the job’. The scale of additional funding beyond the $C1.2B already committed seems to be quite considerable.

“The total incremental cost of this integrated vision over the next 10 years is estimated to be between $10 billion and $12 billion in additional capital, and between $1.5 billion and $1.7 billion in annual operating costs (Figure 6). This does not include the additional ~$3.5 billion to $4 billion cost to provide integrated systems to allied health professionals and the broader community care environment (e.g., all long-term care facilities, home care, public health, and mental health).”

It is fair to say the only way this will happen is because there has been real and measurable progress thus far. We will have to wait and see what the Canadian budgetary process does with this request – given the proof of considerable progress to date.

It is interesting that this works out to approximately $C350 per capita. If applied to Australia and converted to Australian Dollars (1.00 CAD = 1.11914 AUD) would be of the order $A 8.23 Billion over 10 years. To attract that sort of funding we will really need a persuasive plan!

The benefits from implementation are estimated to provide a payback period of eight to ten years even allowing for ongoing operational costs and upgrades etc. Beyond this time frame the benefits will assist in ensuring the sustainability of the Canadian Health System into the future.

The last, and most obvious point it that it is clear Canada now has an implementable Health IT Vision and Strategy – and some real strategic runs on the board to date. We, on the other had, still seem to languish. Mr Abbott and Mr Eccles are you listening! This document is really worth a read as an example of what might help us here in Australia move forward!

David.

The Most Important Report So Far this Year!

Almost as a sleeper, out of the blue, a press release appeared in my inbox from the Office of the National Health IT Co-ordinator (ONCHIT) of the US Department of Health and Human Services. On the basis it is a press release I assume the US would not mind me passing it on to readers of this blog.

Begin Release -----

Prototype Architectures Summary Report Now Available

The Office of the National Coordinator for Health Information Technology (ONC) has released the Summary Report of the NHIN (Nationwide Health Information Network) Prototype Architectures. Key services and technical needs for the development of the NHIN are identified and detailed.

During the past year, four prototype architectures were developed, tested and successfully demonstrated. This collaborative work was completed by consortia led by Accenture, Computer Sciences Corporation, IBM and Northrop Grumman. This work addressed numerous critical issues for the “network of networks” that will be the NHIN. The prototype architectures describe methods to ensure privacy and security, consumer management of personal health records and information support for clinicians while are making clinical decisions.

The Summary Report catalogs the first year’s work and details common elements that will be used in the next step in the NHIN – “NHIN Trial Implementations.” The trial implementations will target state and regional health information exchanges (HIEs) in order to reflect the critical role of data exchange at the state level. The Request for Proposals (RFP) for the NHIN Trial Implementations is available at www.fedbizopps.gov . This phase of the NHIN development effort is expected to be conducted over twelve months (with two option years). The NHIN development process was structured to take the best elements of these prototype architectures and incorporate them into the NHIN Trial Implementations.

The Summary Report is a valuable working document designed to directly engage the state and regional HIEs that will be the “networks” that help make up the “network of networks” for the NHIN. The report was compiled by Gartner, Inc.

The report can be found on the HHS Health Information Technology website www.hhs.gov/healthit

Release Ends ----

The report can be found at the following URL:

http://www.hhs.gov/healthit/healthnetwork/resources/

It is described as follows:

Summary Report on the Prototype Architectures (PDF - 1.73MB) and is downloadable by clicking on the hyperlink.

What is contained in the reports is a summary of an assessment by the Gartner Group four prototypes described above and analysis of how the US can now proceed to develop a National Health Information Network (NHIN) – based on appropriate standards and the already developed national Internet infrastructure.

Among the paragraphs from the Executive Summary that really caught my eye are the following:

“A cornerstone in the plan for interoperable health information technology is the progress that has been made toward enabling the creation of a Nationwide Health Information Network (NHIN), a “network of networks” that will securely connect consumers, providers and others who have, or use, health-related data and services, while protecting the confidentiality of health information. The NHIN will not include a national data store or centralized systems at the national level. Instead, the NHIN will use shared architecture (services, standards and requirements), processes and procedures to interconnect health information exchanges and the users they support.”

And that thus are we can report:

“Initial Successes

These contracts each validated important basic principles that underlie the current approach to the NHIN. These principles include:

· The possibility of operating the NHIN as a network of networks without a central database or services

· The criticality of common standards for developing the NHIN, particularly in the way that component exchanges interact with each other

· Synergies and important capabilities can be achieved by supporting consumers and healthcare providers on the same infrastructure

· Consumer controls can be implemented to manage how a consumer’s information is shared on the network

· There can be benefits from an evolutionary approach that does not dictate wholesale replacement or modification of existing healthcare information systems”

And lastly that:

The Synthesized Approach

The general approach of the contractors had much in common. Specifics varied to the degree that was expected from four independent efforts. Each contractor considered the NHIN as a set of distributed HIEs that work together to become the NHIN. They each identified specific functions that must be provided by the HIEs, including:

• Supporting secure operation in all activities related to the NHIN
• Protecting the confidentiality of personally identifiable health information as it is used by those who participate in the NHIN
• Reconciling patient and provider identities without creating national indices of patients
• Providing a local registry which may be used, when authorizations permit, to find health information about patients
• Supporting the transfer of information from one provider or care delivery organization to another in support of collaborative care
• Supporting secondary uses of data while protecting the identity of patients to the degree required by law and public policy

What this report makes clear is that, with attention to planning and detail, there is a clear viable incremental pathway towards the Health Information Network Australian also needs and that the technology to achieve what is needed is well within our grasp. The approaches adopted by all the participants were also very much Standards based.

It should also be noted the proposed approach also avoids the need for the NEHTA identity initiatives. I hope the architects of NEHTA’s non-plan carefully review what I think is an absolutely invaluable contribution to the development of National Health IT initiatives virtually anywhere. I look forward, with barely constrained excitement, to the outcomes of the work to be undertaken over the next year or so.

David.

Useful and Interesting Health IT Links from the Last Week – 10/06/2007

Again, in the last week I have come across a few reports and news items which are worth passing on.

These include first:

http://www.theage.com.au/news/opinion/the-access-card-has-stalled-so-now-lets-really-talk-about-it/2007/06/07/1181089232478.html

The Access Card has stalled. So now let's really talk about it

Christopher Scanlon
June 8, 2007

FORTY million dollars. Forty million dollars of taxpayers' money, $3 million of which went on an advertising campaign. That's how much this Government — a government that flaunts its reputation as a competent economic manager — just blew on a card. A card, what's more, that doesn't exist and hasn't even received parliamentary approval.

Speaking at the Australian Smart Cards Summit on Tuesday, Senator Chris Ellison conceded that the Government's trouble-prone Access Card is to be delayed, probably until after the election. The official reason is to allow for greater consultation with the states and the territories.

That's a refreshing change, given that the Government has so far shown very little interest in consultation. The Access Card was unsuccessfully rammed through the Senate in a deliberate attempt to limit debate.

The good news is that the card's delay will give the breathing space for some debate about the proposed card. Concerns about privacy ought to be uppermost. The various ministers charged with implementing the Access Card have consistently claimed that the proposed card wouldn't impinge on privacy, since it would carry only the information that is at present held on a driver's licence.

….. (more at the URL above)

This article is a good exposition of the concerns many have regarding the Access Card proposal. I have included it to remind readers that the whole proposal would appear to have unravelled in the last week or so and that there is a range of commentary that has been published recently.

Another quite useful article can be found here:

http://www.theaustralian.news.com.au/story/0,20867,21873560-28737,00.html

A question of identity on the cards

• Despite rejigs and jitters, the federal Government is pushing ahead with the nation's first ID database, reports Natasha Bita
• June 09, 2007

BY this time next year, the federal Government hopes to be interviewing and photographing 35,000 Australians each day to create the nation's first ID databank. Biometric photos, matched with names, addresses, dates of birth, signatures, sex, social security status and children's details, would be loaded into a new centralised database. Welfare bureaucrats, ASIO, the Australian Federal Police and possibly even the Australian Taxation Office would have some form of access to the unprecedented collection of identity data.

….. (more at the URL above)

The debate serves to remind just how contentious identification schemes can be and reminds me how hard it may be for NEHTA to get the legislation it suggests if needs for the proposed Individual Health Identifier through the National Parliament. Watch this space is all I can suggest!

Second we have:

http://govhealthit.com/article102804-06-04-07-Print

Smyth: One size does not fit all

By Jack B. Smyth
Published on June 4, 2007
It is an admirable goal of the Certification Commission for Healthcare Information Technology (CCHIT) to hold all electronic health record (EHR) solutions to the same rigorous certification standards to ensure consistent premium health care for all patients. This goal has held the health care IT community to much needed higher standards. However, in some cases, this may not be in the best interest of small to midsize doctor’s offices and, ultimately, their patients.

….. (more at the URL above)

This is an interesting article pointing out that if one plans to certify EHR functionality when trying to serve a range of user categories and capabilities a one size fits all approach may not be ideal. If we ever move to some similar system (as I believe over time we will) the issue should be addressed pre-emptively.

Third we have:

http://www.govtech.com/dc/articles/123660

"Star Trek" Communication a Reality for Medics with Wireless Technology

May 31, 2007, By News Report

Healthcare facilities across Canada are saving lives and transforming patient care using advanced mobile communications technology from IBM reminiscent of "Star Trek."

The systems provide medical professionals with instant two-way voice communication through lightweight, wearable badges -- similar to devices seen on the popular sci-fi TV show, although at a hospital the voice command is more likely to be "send the MRI images" than "Captain Picard to the bridge." The devices also can relay text messages and alerts.

In the past six months, IBM signed five services contracts totaling more $500,000 for secure, wireless networks to provide clinicians in surgical wards, emergency rooms and critical care units with hands-free, real-time voice communication technology.

The communicators, developed by Vocera Communications Inc. and supported by an IBM wireless network, can increase staff productivity, save time and improve patient care response times. Physicians and other health care professionals can quickly and easily connect, without stopping what they are doing to look for colleagues or place a phone call or page -- time that could make the difference between life and death in an emergency.

….. (more at the URL above)

For an old Star Trek addict this seems to me like a great idea and to be technology I would have loved to have access to in the Intensive Care and Emergency units is spent so much time in in the days before Health IT.

Fourth we have:

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_034252.hcsp?dDocName=bok1_034252

The RFP Process for EHR Systems

Implementing an electronic health record (EHR) requires substantial time and money for healthcare providers of all sizes and types. During the EHR selection process, organizations must dedicate sufficient time and resources to evaluate their goals and business needs, in addition to thoroughly reviewing available EHR vendor products and services.

This practice brief guides organizations through the selection process, assisting providers as they issue requests for information or requests for proposal for EHRs or component systems. It was developed to be used in conjunction with the “RFI/RFP Template” [...].

….. (much more at the URL above)

This is a very useful contribution from the American Health Information Management Association. While not tailored for Australian conditions all those procuring Health Information Systems should ensure they have covered all the relevant material raised here. My reading suggests they have well and truly covered all the major bases!

Lastly we have:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070605/FREE/70605006/1029/FREE

Rx groups' drug history database emergency-ready

By: Joseph Conn / HITS staff writer

Story posted: June 5, 2007 - 12:13 pm EDT

Two not-for-profit pharmacy trade groups and three for-profit pharmacy companies have joined with the American Medical Association to create a national database to give providers access to patients' drug histories during emergencies. The Web-based service could be activated by the groups and companies in the event of a natural disaster or other emergency, giving physicians and other providers access to the data.

ICERx, or In Case of Emergency Prescription Database, is an outgrowth of a 2005 collaboration by the same groups and companies in the wake of Hurricane Katrina. Their goal was to create a resource for physicians and other healthcare providers treating Gulf Coast patients whose medical records were destroyed or made inaccessible, an effort called KatrinaHealth.org.

….. (more at the URL above)

It seems clear that with the recent NSW storms, Cyclone Larry etc that such a service could be very useful here. I wonder has Medicare Australia considered such a capability as part of their e-prescribing initiative. I certainly hope so.

Other useful finds this week include:

http://www.chcf.org/topics/chronicdisease/index.cfm?itemID=133289

Perspectives on the Future of Personal Health Records

Christopher J. Gearon

June 2007

This is a link to a useful freely downloadable report on how Personal Health Records may evolve. In this report, six experts share their views on the future of PHRs, from the perspective of the technologist, informed patient, physician, employer, and public health professional. Worth a download.

http://www.oregonlive.com/business/oregonian/index.ssf?/base/business/1181181333174410.xml&coll=7

House OKs bill for informatics education

The House yesterday approved legislation that would help fund college and master’s level education in healthcare informatics—a move federal lawmakers say will help advance the use of electronic health records and bring greater transparency and quality to the industry.

http://www.informationweek.com/software/showArticle.jhtml?articleID=199902333&cid=RSSfeed_IWK_News

'Sustainable' E-Health Data Exchange Debuts

The new eHealth Value and Sustainability Model and related tools aim to help regional health-care providers.

By Marianne Kolbasuk McGee, InformationWeek
June 7, 2007

This is a useful resource for those exploring the implementation of Health Information Sharing.

http://www.ihealthbeat.org/articles/2007/6/8/National-Health-IT-Network-To-Be-Built-From-Bottom-Up.aspx?a=1

June 08, 2007

National Health IT Network To Be Built From Bottom Up

by Kate Ackerman, iHealthBeat Associate Editor

As recent action has shown, the federal government is tapping local, state and regional health data exchanges to be the building blocks of the Nationwide Health Information Network.

http://www.hhs.gov/healthit/

The home page for the Federal US Health IT strategy and progam.

Health Information Technology Home

Health Information Technology

Health information technology (Health IT) allows comprehensive management of medical information and its secure exchange between health care consumers and providers. Broad use of health IT will:

• Improve health care quality;
• Prevent medical errors;
• Reduce health care costs;
• Increase administrative efficiencies;
• Decrease paperwork; and
• Expand access to affordable care.

Interoperable health IT will improve individual patient care, but it will also bring many public health benefits including:

• Early detection of infectious disease outbreaks around the country;
• Improved tracking of chronic disease management; and
• Evaluation of health care based on value enabled by the collection of de-identified price and quality information that can be compared.

http://www.hhs.gov/healthit/news/Accomplishments2006.html

This URL provides a useful overview of the top level US Strategy and Approach.

http://www.hhs.gov/healthit/healthnetwork/resources/summary_report_on_nhin_Prototype_architectures.pdf

Summarises the prototype National Health Information Network Pilots. Written by Gartner and well worth review.

While most readers must be sick of me saying it – wouldn’t it be nice if the Australian Government e-Health Initiatives had the same degree of strategic clarity.

All in all quite an even more bumper week!

More next week.

David.

An Emerging Consensus on the AHIC Survey?

As regular readers will recall, on Monday I posted some commentary on the Australian Health Information Council (AHIC) Survey questionnaire, which is being conducted by the Nous Group.

The article can be found here:

http://aushealthit.blogspot.com/2007/06/ahic-survey-will-they-hear-what-they.html

What has been interesting, in discussing the survey with colleagues, is the unanimity on the importance of having a plan.

I think this is because it is recognised, and clear to all that developing ‘building blocks’ without knowing how you want the house operate and what appearance you want is quite silly.

While I don’t want to argue semantics - I see the focus on these building blocks - without having a concept of what the house is to look like and who it is to accommodate as extremely problematic.

As it happens every nation I know of that has thought about a national e-health strategy has come up with the same list (messaging, identifiers and terms) and I see all of them a critically necessary but not sufficient. We still need systems and applications to take advantage of what I see as just essential shared infrastructure

It seems to me that if the AHIC Board get only one message from the current survey this will be it – we need a plan! The next question that then arises relates to just what sort of plan is required and how is it to be developed.

I think it is important to respond to this question and a number of readers have suggested they would like to know what my thinking might be. Let me say first off I recognise the complexity and difficulty of this and am confident I have no unique hold on wisdom in all this. I will provide an opening view and would be keen to hear any and all comments.

The best way I can think of to approach the issue is to consider what I believe should be some of the principles that should underpin the plan and shape the approach and methodology of its development and subsequent implementation.

Before providing the principles I think it is important to note that we have now had a decade of grand plans (since the House of Reps report in 1997) and expensive trials which have not got us very far, as best anyone can tell. So grand detailed top down plans need to be treated with healthy scepticism.

What principles might lead to a successful plan and subsequent implementation.

First cab off the rank for me would be to get an accurate unbiased situation report of where we are. What is working, what is not, what are the reasons for success and failure etc. This is quite a large task and would require review of all the initiatives and trials from the last decade in a clear eyed and objective fashion. There would also need to be quantitative review of the success of the various adoption incentive programs to fully understand what value has been obtained from these initiatives.

Next it would be important to try an obtain a similar clear eyed view of just what was happening globally and the factors that could be shown to be leading to success or the opposite and what could be done to mitigate risk.

Once such situational information was available it would then be reasonable to develop a range of possible high level approaches and workshop and refine those with relevant stakeholders. This step needs to be conducted in an inclusive, open, transparent and consultative manner.

It is also important in undertaking this consultation to be clear that the technology needs to be the servant of the health system and to be implemented in such a way that assists the health sector achieve its objectives of safety, consistency, quality, effectiveness and value for money.

There are a range of strategic choices that will need to be made, and these choices need to be made on the basis of what suits the operation of the Australian health sector and those who work in it. Among the choices that need to be made are:

1. The balance between, and what will be, standardised nationally, at a state level and locally.

2. The priority to be placed on support of the primary, secondary, tertiary, investigative and public health / preventative aspects of the health sector.

3. The importance that is to be placed on information standardisation to assist in health system information aggregation and reporting.

4. How the distribution of benefits from the use of technology are going to be distributed and what incentive and adoption facilitation mechanisms are to be employed.

5. What level of investment will be made in developing health IT, who will invest and over what time period.

6. What of the current e-health infrastructure needs to be retained and what needs to be replaced. How can we best build on what is working today and ensure there is a future for those things that have proven to be useful and valuable

7. What approach to governance, reporting and evaluation should be adopted. What bodies are needed, what functions should they perform and what expertise needs to reside where?

8. What will be the optimal approach to develop and maintain public support for improved e-Health services.

9. How can enough skilled people be trained to address the needs of both plan development and implementation?

10. How best can the private sector be involved as both providers and vendors in a national initiative? What roles should each play?

This is a high level list which barely scrapes the surface, is certainly incomplete, but should provide an initial understanding of the scale of the effort required. A workable, practical, supportable, fundable and implementable plan will require a lot of hard work and good will. We have series of failures to recover from and we really should give it a very thorough and rigorous try!

I need to be clear here. I understand the risks of the grand plan and want a balance that works for Australia. I think we need to develop some organising principles and direction and then to get on with it – National e-Health Strategy Lite maybe! However we do need some clear sensible frameworks, standards etc and we certainly need to understand what has gone wrong in the last decade. The strategic vacuum approach has not been seen to work and we need not to continue down that path any longer.

David.

There is Hope!

The last 24 hours have been just amazing in what I am hearing from all sorts of sources!

Behind the scenes, in all sorts of ways, the agenda this blog has been trying to propose is receiving a better hearing than could have been imagined even a month or two ago.

The recognition that changes in NEHTA's approach to stakeholders is desperately needed seems now to be accepted. It is now also very clear, as a lesson, that really working collaboratively is critically important.

The black hats are recognizing their day in the sun is at an end and that change is in the wind. I wish I could share more - but what is going on is at a tipping point and I need to just let the actors play it all out.

I am sure in the next month or two policy will emerge that makes many of the readers of this blog much happier. The tipping point has arrived, I think, and we all need to be patient as the processes play out - hopefully for the good of all - we shall see.

Sorry I can't be more specific - but I have to respect my sources!

Be patient and keep doing the worthwhile stuff.. and I think there is a real chance of change.

I really hope I am right!

David.

Minister Abbott Responds to Open Letter of March 11, 2007

Below I have provided a scan of the letter I received from Mr Richard Eccles who is First Assistant Secretary, Primary Care and Ambulatory Division of the Commonwealth Department of Health and Ageing. (click the image to read)

The really good news is provided in the second paragraph where we are told “The Australian Government agrees that better clinical outcomes and improved efficiencies can be achieved with better use of e-Health” while pointing out patient choice, privacy and confidentiality are matters that need to be carefully and fully addressed.

I will leave it for readers to form a judgement on just how much progress has actually been made for the funds expended and whether what has been done has been cost effective. On the basis of there being 36,300 GP(s) in 2005 it seems the Practice Incentive Program (at $40,000 per practitioner) has cost $1.432B or so over the last few years. When this is added to the other sums mentioned ($310M) to total expenditure (not including the $105 Million for NEHTA) is perilously close to $2.0Billion.

It seems to me, prime face, that spending $128 Million on providing an electronic health record for 10,000 people could hardly be seen as cost effective. Heavens, to expand to the population in general we would then be over $256 Billion (about a quarter of the national GDP). If even 5% of this sum could be found life would be just wonderful!

It should be pointed out that to date there have been no reports on the clinical impact of any of these initiatives that are seen as credible. It is a lot of money that might have been spent inappropriately!

Back to the good news. It is important to read work is actively underway on e-prescribing. It would be good if the plans for this were being developed more transparently with more discussion with all the relevant stakeholders.

In the second last paragraph we are told a combination of financial incentives, regulatory reform and Standards development are being supported to move the agenda on. All good as far as it goes – BUT – without a coherent e-Health Strategy that brings all these parts together will may well wind up wasting a good fraction of the next $2Billion if a second chance is ever offered.

Overall the lack of identification of the Australian Health Information Council’s (AHIC) importance to provide a workable strategy is worrying. NEHTA is not the answer for this problem. We can only hope AHIC is.

Many thanks for the good news Mr Eccles. Now can we have a plan please?

David.