Comparative Hospital System Performance Web Sites – A Good Thing?

In the last few years there has been a push to let consumers know a great deal more about Hospital and health system performance. This interesting article appeared a few days ago.

Value of Health Care Cost, Quality Web Sites Might Be Overestimated

by Kate Ackerman, iHealthBeat Associate Editor

Three-fourths of health care opinion leaders responding to a November 2007 Commonwealth Fund/Modern Healthcare survey said that increased quality and price transparency is important or very important to improving the U.S. health care system.

In the last couple years, several states, payers and other health care organizations have responded to this demand for transparency by developing online health care cost and quality Web sites. The thinking is that by providing consumers with information to make informed health care decisions and by injecting competition into the health care market, costs will decrease and quality will increase.

However, consumers so far have been slow to use the information, and physicians often don't know how or if they should act on the data. Touting the sites as a mechanism to transform the health care system might be overestimating their value, some health experts say.

Continue reading this excellent article here:

http://www.ihealthbeat.org/articles/2008/2/8/Value-of-Health-Care-Cost-Quality-Web-Sites-Might-Be-Overestimated.aspx?a=1

Further web information can be found at the links below:

• Center for Studying Health System Change
• Colmers, "Public Reporting And Transparency," Commonwealth Fund, 1/07
• Commonwealth Fund/Modern Healthcare Opinion Leaders Survey

The issue has also been explored recently (as previously mentioned on the blog) in the following article:

http://www.annals.org/cgi/content/abstract/148/2/111

Systematic Review: The Evidence That Publishing Patient Care Performance Data Improves Quality of Care

Constance H. Fung, MD, MSHS; Yee-Wei Lim, MD, PhD; Soeren Mattke, MD, DSc; Cheryl Damberg, PhD; and Paul G. Shekelle, MD, PhD

15 January 2008 | Volume 148 Issue 2 | Pages 111-123

Background: Previous reviews have shown inconsistent effects of publicly reported performance data on quality of care, but many new studies have become available in the 7 years since the last systematic review.

Purpose: To synthesize the evidence for using publicly reported performance data to improve quality.

Data Sources: Web of Science, MEDLINE, EconLit, and Wilson Business Periodicals (1999–2006) and independent review of articles (1986–1999) identified in a previous systematic review. Only sources published in English were included.

Study Selection: Peer-reviewed articles assessing the effects of public release of performance data on selection of providers, quality improvement activity, clinical outcomes (effectiveness, patient safety, and patient-centeredness), and unintended consequences.

Data Extraction: Data on study participants, reporting system or level, study design, selection of providers, quality improvement activity, outcomes, and unintended consequences were extracted.

Data Synthesis: Forty-five articles published since 1986 (27 of which were published since 1999) evaluated the impact of public reporting on quality. Many focus on a select few reporting systems. Synthesis of data from 8 health plan–level studies suggests modest association between public reporting and plan selection. Synthesis of 11 studies, all hospital-level, suggests stimulation of quality improvement activity. Review of 9 hospital-level and 7 individual provider–level studies shows inconsistent association between public reporting and selection of hospitals and individual providers. Synthesis of 11 studies, primarily hospital-level, indicates inconsistent association between public reporting and improved effectiveness. Evidence on the impact of public reporting on patient safety and patient-centeredness is scant.

Limitations: Heterogeneity made comparisons across studies challenging. Only peer-reviewed, English-language articles were included.

Conclusion: Evidence is scant, particularly about individual providers and practices. Rigorous evaluation of many major public reporting systems is lacking. Evidence suggests that publicly releasing performance data stimulates quality improvement activity at the hospital level. The effect of public reporting on effectiveness, safety, and patient-centeredness remains uncertain.

These two articles explore the issue of just how useful complex information is to consumers. It seems to me that while lacking transparency is always a bad thing it is vital that the information that is released is both easily understandable and comparable so the consumer has something reliable to base decision making on.

As noted in a previous blog there are well thought out comparable clinical outcome performance indicators available and it is these that should be used – with appropriate explanations – to inform the public on hospital performance.

It is interesting to note that the major effect that has been detected following data release is an increase in internal quality improvement activity. If this activity is well directed this over time is surely a good thing indeed and makes such transparency a reasonable goal –with the caveat that the indicators being worked on a relevant and accurately reflect desired clinical and patient outcomes.

It seems to me this is still a work in progress.

David.

A National E-Health Strategy for Australia is Coming! Can it Succeed?

Well, blow me down! I have just had one of my core suggestions taken up! We are to have a National E-Health Strategy developed!

The important parts of the tender are as follows: (Sorry for the formatting - useful comments are at the end.)

Part A. Information for Tenderer

Purpose of this Document

This document is a Tender Brief and has been prepared to provide information to assist prospective Tenderers in the preparation and submission of proposals for the development of a national e-health strategy.

Project Overview

On behalf of the National e-health Information Principal Committee (NEHIPC) the Department of Human Services is seeking suitably qualified and experienced parties to develop a national e-health strategy that:

· Provides a vision for and desired outcomes of national action in e-health over the next 5-10 years

· Identifies priorities and next steps for development and implementation of a national e-health system

· Provides advice on the governance arrangements needed to oversight and manage national e-health projects and infrastructure

Key dates for this proposal are indicated below. These dates are advised as a guide to projected timelines, only. The Department of Human Services will attempt to maintain this schedule, but reserves the right to vary key dates where necessary:

Tenders advertised	13 February 2008
Closing date for submission of Tenders	7 March 2008
Shortlisting completed by	11 March 2008
Interviews conducted by	14 March 2008
All tenderer A Tenderers advised of Tender outcome by	28 March 2008
Service/project commencement by	28 March 2008
Service/project completion	28 July 2008

Project Objective

The objective of this project is to develop a national e-health strategy through the identification of a national vision and goals for e-health. The strategy recognises existing and projected national and international efforts in e-health while also considering future developments in health service delivery. The strategy provides a practical roadmap for further national e-health development and implementation in this country, and allows prioritisation of existing and future investment in national e-health infrastructure and activities.

The strategy should:

Specify a vision for e-health in a national context to include discussion of:

· Models for health service delivery

· Enablers for improved efficiency and quality

· Consider population and demographic changes

· Workforce and skills

· Service delivery sustainability

· Physical transportation

· Emerging risks and influences

· Plan for change

· Identify drivers and influences of change

· International influences – vendors, products and standards

· National and jurisdictional legislation

· Identify key priorities, goals and practical strategies and initiatives to support the national e-health vision

· Identify options for next steps in national collaboration in e-health over the next 5 - 10 years, which leverages existing national and international investment and experience. This must include:

· A review of the scope, funding and timetabling of existing and future significant national and state government e-health projects and initiatives. This would be based on an audit commissioned by NEHTA within the last 2 years and direct consultations with jurisdictions regarding any more recent developments;

· Advice on priority areas for progressing national collaboration in e-health (in accord with health system reform priorities including desired outcomes and models of care) and the benefits to be derived from proposed initiatives;

· Analysis of international experience that may guide prioritisation and practical implementation of e-health initiatives in Australia;

· Advice on a practical pathway for optimal pursuit of national e-health priorities, including timelines and parties responsible for each milestone. Gaps in current effort, incentives to promote uptake and opportunities to harness learnings from existing programs and projects must be identified. The pathway should identify necessary action and responsible parties to deliver sharing and utilising health information electronically, including incentives for uptake and any possible sanctions.

· Provide options for strengthened e-health governance. This must include:

· An analysis of existing national governance arrangements for both e-health and information management under the Australian Health Ministers’ Advisory Council (AHMAC);

· Options for strengthened AHMAC governance arrangements in line with national e-health directions, including how any new arrangements align with other organisations and committees progressing the national e-health agenda;

Identification of governance structures needed to oversight and manage national e-health priorities, including e-health infrastructure and programs. In considering these structures reference will need to be made to the regulatory arrangements necessary for the effective and efficient operation of the future national e-health environment.

Scope

“E-health” is defined by the World Health Organisation (WHO) as ‘the combined use of electronic communication and information technology in the health sector.’ It refers to the health care components delivered, enabled or supported through the use of information and communications technology. Examples include clinical communication systems such as online referrals and e-prescribing, and electronic health records. E-health is identified as a key enabler of models of care delivery, patient centred care, supported self-care, remote access and monitoring, and health system sustainability.

The strategy should recognise existing national and jurisdictional efforts and investments in e-health by Australian, State and Territory health departments, the National E-Health Transition Authority (NEHTA), the Australian Health Information Council (AHIC) and the National E-Health and Information Principal Committee (NEHIPC).

The strategy should focus on those aspects of e-health which are both necessary and sufficient to establish robust and effective national approaches to the creation, communication, storage, use and analysis of information.

The national e-health strategy should be inclusive of both public and private health sectors, to guide the next phase of national e-health collaboration.

The strategy will articulate priorities for e-health that are measurable and grounded in local and international evidence.

The strategy will need to take account of the current and emerging issues in health service delivery facing government (Commonwealth, States and Territories), health care providers and consumers, in identifying priorities and governance arrangements.

The e-health strategy will address the dimensions of information, information management (for primary clinical purposes and secondary reporting, evaluation and research), information technology, communications technology, medical technology and all associated enabling infrastructure (such as policy and legislative frameworks). It must assess and leverage work completed to date or currently underway.

Period of Service

The period of service is to commence on 28 March 2008 and the contract period will be for 3 months, ceasing on 28 July 2008.

Extension of Contract

Subject to satisfactory performance and agreement of the successful Tenderer, the Department of Human Services reserves the right to extend the contract period to a total period of 6 months.

Background

Department of Human Services

The Department of Human Services, Victoria, on behalf of the Australian Federal, State and Territory Health Departments and the NEHIPC, is seeking suitably qualified and experienced parties to develop a national e-health strategy.

The Department of Human Services is responsible for a wide range of services to diverse client groups across Victoria. The principal function of the Department of Human Services is to ensure the delivery of a range of health, housing and community services.

The Department of Human Services’ Mission Statement is:

To enhance and protect the health and well being of all Victorians, emphasising vulnerable groups and those most in need.

Policy Context

In 1993 the Australian Government and the States and Territories, recognizing the importance of a strategic national approach to the development of health information management and information communications technology, signed the first National Health Information Agreement (NHIA). The NHIA between the Australian Government, the State and Territory health authorities, the Australian Bureau of Statistics and the Australian Institute of Health and Welfare provides the foundation for the development, collection and exchange of uniform health data and information and tools to support analysis, research and comparison at all levels of the health system.

National governance arrangements were established under the NHIA to oversee developments in statistical standards and other national information projects. Under the first NHIA uniform national data standards were developed and the National Health Data Dictionary, which contains metadata standards for a range of health services, was established.

In 1995 the National Health Information Development Plan was released, promoting the development of high priority health information and equitable cost effective service arrangements. In 1998, the National Health Information Management Advisory Council (NHIMAC) was established to advise Health Ministers on options to promote a national uniform approach to more effective information management in the health sector. In 1999 NHIMAC released Health Online: A Health Information Action Plan for Australia. Under Health Online national action plans were developed focusing on health information standards, telehealth, supply chain reform in hospitals and electronic decision support.

Australian Health Ministers established the National Electronic Health Records Taskforce in November 1999 to evaluate the potential of electronic health records for the Australian health care system. Based on the Taskforce recommendations, Ministers agreed in July 2000 to jointly fund a two year project to assess the value and feasibility of HealthConnect. The purpose of HealthConnect is to facilitate the adoption of common standards by all e-health systems so that vital health information can be securely exchanged between healthcare providers. HealthConnect trials have been operating in the Northern Territory and Tasmania since 2002. Trials commenced in North Queensland in 2003 and in New South Wales and Brisbane in 2005.

Health information management and technology governance arrangements evolved over this period with the establishment in 2003 of the Australian Health Information Council (AHIC) and the National Health Information Group (NHIG). AHIC and NHIG were established to provide leadership on information management and technology, and to coordinate advice to Health Ministers. The key role of AHIC is to provide independent advice to Health Ministers, via the Australian Health Ministers’ Advisory Council (AHMAC), on long term directions and strategic reform issues. NHIG was established to provide advice to AHMAC on planning and management requirements, and to manage and allocate resources to health information projects and working groups.

During 2005 and 2006, AHMAC reviewed its subcommittee and working group structures. As a result of the review, NHIG became the AHMAC Principal Committee on National Health Information Management (NHIMPC). In December 2007, AHMAC CEOS considered advice commissioned from KPMG regarding the scope and governance arrangements for strategic development of health information management in Australia. In January 2008, AHMAC agreed that the NHIMPC be reconstituted to take on a broader responsibility in relation to e-health alongside its existing focus on information management. Reflecting this broader focus the Principal Committee has been renamed the National E-Health and Information Principal Committee (NEHIPC), with the new structure and membership yet to be finalised.

Provisional meeting dates for AHMAC in 2008 are as follows:

· 6 March (Hobart)

· 5 June (Melbourne)

· 9 October (Adelaide)

Provisional meeting dates for the NEHIPC in 2008 are as follows:

· 16 April (Melbourne)

· 19 July (teleconference)

· 17 September (Melbourne)

· 26 November (Melbourne)

NEHIPC is chaired by Ms Fran Thorn, Secretary of the Department of Human Services in Victoria. The NEHIPC currently comprises a representative from each Australian jurisdiction (as its core membership) and a representative from the Australian Health Information Council, the Australian Institute of Health and Welfare, the Australian Bureau of Statistics, the National Health and Medical Research Council, Medicare Australia, the Australian Commission on Safety and Quality in Health Care, the Department of Veteran’s Affairs and the New Zealand Ministry of Health.

A number of standing committees and set for purpose working groups provide specialist advice to NEHIPC, and the Chairs of these committees/groups also attend NEHIPC meetings as observers. These currently include the:

· Statistical Information Management Committee (SIMC);

· Health Data Standards Committee (HDSC);

· National Health Performance Committee (NHPC);

· Population Health Information Development Group (PHIDG); and

· National Advisory Group on Aboriginal and Torres Strait Islander Health Information and Data (NAGATSIHID).

In 2005, Australian Health Ministers noted the need for further cooperation on significant national e-health projects including clinical data standards and terminologies, consent models, secure messaging, user authentication, supply chain and electronic health records standards. This was endorsed by the Council of Australian Governments in June 2005. The National E-Health Transition Authority Ltd (NEHTA) was established in July 2005 to support the adoption of e-health in the Australian health sector.

On 10 February 2006 Council of Australian Governments (COAG) agreed that:

From February 2006, governments will accelerate work on a national electronic health records system to improve safety for patients and increase efficiency for health care providers by developing the capacity for health providers, with their patient’s consent, to communicate safely and securely with each other electronically about patients and their health. This requires:

· Developing, implementing and operating systems for an individual health identifier, a healthcare provider identifier and agreed clinical terminologies; and

· Promoting compliance with nationally-agreed standards in future government procurement related to electronic health systems and in areas of healthcare receiving government funding.

(Better Health for all Australians, COAG Communiqué, February 2006)

Funding was assigned to NEHTA to progress three significant infrastructure projects in the development of e-health, namely to establish the Individual Healthcare Identifier (IHI), the Healthcare Provider Identifier (HPI) and to establish a national clinical terminology. These three initiatives form the building blocks towards a national approach to a Shared Electronic Health Records system. COAG further agreed that Australian Health Ministers would report back to COAG no later than 2008 on progress and next steps towards a national e-health records system and appropriate cost sharing arrangements.

In December 2007, both the Australian Health Information Council (AHIC) in its report e-Health Future Directions and the Boston Consulting Group in its review of NEHTA, recommend the development of a national e-health strategy. It is also one of the key tasks listed in the revised terms of reference for NEHIPC endorsed by AHMAC in January 2008.

And also this part is important.

Key project deliverables are:

· A draft and final strategy fulfilling the requirements articulated in 3. and 4. To include:

Ø A discussion and key recommendations concerning the National eHealth Strategy, the Implementation Plan and the recommendations on governance of the implementation plan

Ø A vision, implementation and sustainability plan for e-health in Australia and its role in the planning, delivery and management of healthcare in this country.

o A recommended “future state” of e-health in the context of its proposed role in the planning, delivery and management of healthcare across Australia

o A definition and assessment of the current status of e-health capability, nationally both public and private, as well as at a jurisdictional level, with an assessment of the current level of contribution e-health is making to healthcare delivery and management and the investment in place to support this.

o Concept architectures and designs including information to support decisions taken in developing these. This must clarify which major components should be managed centrally (national), which could be either central or distributed (jurisdictional) and what should be geographically/regionally based.

o Identification of the major initiatives that would need to be undertaken to develop an e-health capability that optimally supports the Australian healthcare system and how each initiative will impact health outcomes and healthcare delivery capabilities. Initiatives need to be clearly defined and include high level detail of how impacted business processes would work. Each initiative needs to be scoped with a high level project definition that identifies outcomes, resource requirements, timelines, costs, benefits, dependencies, risks and issues. Costs must be fully inclusive of establishment as well as implementation costs.

o Definition of all enabling work that will be required to support the implementation plan. This will include areas such as standards, legislative and policy frameworks. Identify any changes or development that will need to be undertaken to support the implementation, whether these are already underway (by whom) or who should be addressing them (e.g. information privacy, consent models, additional standards).

o Prioritisation of initiatives to align with current national and jurisdictional health priorities as well as a process to recognise those that will emerge from the National Health and Hospital Reform Commission (NHHRC).

o A high level implementation plan, including assumptions and dependencies, with associated investment, costs and benefits plans. The plan should include strategies and incentives to maximise the take up of new capabilities.

o An assessment of capability in Australia to deliver against the proposed implementation plan. This must, particularly, consider issues of workforce capability (e.g. ICT, health informatics, healthcare) and market capability in this country. Identify strategies to manage these issues and ensure that the Australian workforce develops appropriately.

o An assessment of supply and demand factors in the private sector market for e-health products and services with a particular focus on vendors’ willingness and ability to develop and market products, issues driving private sector health care providers’ to acquire and use those products, and recommended approaches to address any shortcomings identified.

o Proposed governance structures to support and oversee the strategy and the implementation of the plan, including roles and responsibilities

o Description of all enabling work that will be required to support the implementation plan. This will include areas such as standards, legislative and policy frameworks.

o Clear statement of all assumptions that underpin the recommendations and estimated costs.

Ø A high level communication plan regarding the national e-health strategy itself, to inform key stakeholders of the planned future direction.

Ø Presentations and support to briefings related to the e-health strategy as follows:

o Presentations of the final strategy to key stakeholder forums (5 expected including but not limited to the CIO sub-committee of the NEHIPC, NEHIPC and AHMAC); and

o Support to the NEHIPC for related e-health strategy briefings on the final deliverables

o Regular meetings with the project steering committee established to oversee the project. This committee will comprise senior representatives from the Australian Federal, State and Territory health departments.

o Consultations with experts and stakeholders in Australia, as agreed with the e-health strategy steering committee.

==== End of Tender Quotes. (The full tender is available at http://www.tenders.vic.gov.au/domino/web_notes/etenders/etdrpublishing.nsf?Open)

First – let me say it is great to see such an initiative being undertaken. However this is really not a request for the plan that is required I believe. Why?

Firstly, three, or even six months, is not anywhere near enough time to address the complexities that Australian e-Health will face in the next 5-10 years.

Second the idea of using a Current State of e-Health Assessment developed by NEHTA a year or so ago is hardly an ideal information base from which to conceive the future.

Third the documentation seems to ignore the vital fact that the major stakeholder in all this is the Australian population who have a right to more efficient, safe and evidence based care. It is they who need to be convinced investment in e-Health will benefit them. Right now the consumer has no idea why they need EHRs or e-Health.

Fourth the brief is not focussed on a clinical outcomes perspective. By that I mean that the vision should be framed in terms of how the health status of the nation can be enhanced through the use of e-health – not some vision of a technological ‘future state’.

Fifth the strategy documentation does not appear to include development of a specific implementation justification business case to demonstrate the value of implementation of the proposed strategy. A persuasive national business case is the only way the required funding will be made available.

Sixth the overall process and deliverables being requested has a distinct 1980’s Information Systems Planning feel, rather than the dynamic, persuasive and compelling strategy that is needed to energise the health sector to move forward.

Seventh, without clear Health Sector wide analysis of where benefit can be gathered proper prioritisation is difficult if not impossible.

Eighth, all the background information simply tries to deny and sweep under the carpet the mess we have seen over the last decade with shifting priorities, staff turnover, inadequate evaluation of trials and so on. This is not the way to start. An honest look back is vital, before trying to move forward.

Ninth, by doing a short form plan, which is wanted by Government to meet the Health Care Agreement agenda, we don’t get the plan we need. The smart thing would be to use this as a starting point for detailed planning focussed on real outcomes after that issue is sorted.

All in all, unless we can move this retro approach to E-Health Strategy to one more consistent with 2008 and beyond we run the risk of yet another failed planning effort – which would be a huge pity.

David.

NEHTA Decides it Needs Clinical Input – Four Years too Late!

The deeply dysfunctional National E-Health Transition Authority (NEHTA) is off on another frolic!

A day or so ago the following appeared via their web-site:

http://www.nehta.gov.au/index.php?option=com_content&task=view&id=275&Itemid=457

Clinical Team

Australia’s expert clinicians are invited to play a part in health reform through the development of a national e-health system.

The National E-Health Transition Authority considers the clinical perspective of experienced professionals vital to the reform agenda.

We are appointing a team of senior clinicians to provide advice on NEHTA’s development programs as well as support engagement and consultation within the healthcare sector.

A broader clinical network will also be developed through an online community to enable NEHTA to have access to a breadth of knowledge essential for the quality development and implementation of e-health programs.

The clinical leaders and the clinical network will be part of the following NEHTA programs in development:

• Pathology;
• Discharge;
• Referral;
• Medication Management;
• National infrastructure projects:
• Unique Healthcare Identification;
• Clinical Terminologies;
• National Authentication Service for Health;
• Core Connectivity; and
• Conformance, Compliance and Accreditation.

NEHTA will consult widely with leading clinician organisations and is assisted in the development of clinical networks by former Australian Medical Association President Dr Mukesh Haikerwal.

ROLE OF A CLINICAL LEADER

Clinical leaders will be assigned to NEHTA development programs and national infrastructure projects to provide input and guide the development teams on likely clinical issues and appropriate mechanisms for engaging with clinical stakeholders.

Clinical leaders will also be important facilitators within partnership projects, where their involvement on particular issues can provide a perspective independent from that of the business interests of all parties.

The clinical leaders will:

• Advise NEHTA on engagement strategies for NEHTA’s work with clinicians and their representative organisations and to be involved in NEHTA’s engagement with stakeholder organisations as required;
• Work with NEHTA staff to ensure the clinical perspective is understood and provide feedback from a clinical perspective (including clinical safety and quality requirements);
• Work with NEHTA Managers, other clinical leaders, professional bodies, Royal Colleges and clinical opinion makers to anticipate the likely implications of NEHTA’s work on clinical workflow and professional practices;
• Act as an advocate for NEHTA’s work on clinical issues, under the direction of NEHTA with key clinical, jurisdiction, vendor and health consumer stakeholders including professional bodies, Royal Colleges, clinical opinion makers and the media;
• Provide input into the development of clinically-focused communication materials by NEHTA; and/or
• Provide appropriate and timely responses to questions/issues as required.

To read more details about clinical leaders click here.

To express an interest in becoming a clinical leader click here This e-mail address is being protected from spam bots, you need JavaScript enabled to view it to:

• Provide an outline of your interest in e-health or NEHTA's work and the area/s you would like to be involved in; and
• Submit your curriculum vitae including professional qualifications and memberships.

Initial applications close on the 29th February 2008.

Email enquiries about the clinical leader program to clinical@nehta.gov.auThis e-mail address is being protected from spam bots, you need JavaScript enabled to view it

MEMBERSHIP OF A CLINICAL NETWORK

The new clinical network is an online community for clinicians who are interested in e-health and the role technology can play in improving care delivery and healthcare reform. Members of the clinical community will be provided opportunities to comment on NEHTA’s work from a clinical perspective and attend clinical forums and workshops where NEHTA’s developments are reviewed and discussed.

NEHTA is seeking a broad range of clinicians from a variety of specialties who have:

• Tertiary qualifications in a clinical field with clinical experience or knowledge of the Australian health sector;
• Membership of a professional clinical organisation such as the relevant Royal College;
• Exposure to or an understanding of the e-health benefits to care delivery;
• Willingness to share thoughts and provide clinical feedback for NEHTA’s developments.

To register as a member of the clinical network, please click here and describe your interest in e-health or the areas of NEHTA’s work that interests you the most, or would like to be involved in.

Contacts

Helen Murray, Manager – Clinical Engagement

Mukesh Haikerwal, Clinical Lead

This page describes what is expected of clinical leaders

http://www.nehta.gov.au/index.php?option=com_content&task=view&id=276&Itemid=461

CLINICAL LEADERS

The overall outcomes of the clinical leaders program will include:

• Increased engagement, buy-in and support for NEHTA’s work from targeted clinical stakeholders;
• Increased collaboration on NEHTA’s work outputs with key clinical stakeholders;
• Conduits into key clinical representative organisations, ensuring support for NEHTA’s work program;
• Increased dissemination of information about the benefits of the NEHTA’s work to clinical audiences;
• Increased clinical safety and quality of NEHTA’s work outputs by the contribution of clinical expertise to clinical assurance process;
• Increased clinical input into the development, delivery and implementation of NEHTA’s work outputs ensuring that it is clinically fit-for-purpose;
• Increased coverage of the benefits of e-health to the media (including health and general media);
• Demonstrable evidence of engagement of key clinical stakeholders and opinion makers through broad acceptance of NEHTA’s work; and
• Increased clinical awareness for key NEHTA staff and in NEHTA’s work outputs.

Skills

In general, clinical leaders must demonstrate a good network of peer connections within key clinical representative organisations relevant to the particular task they will undertake for NEHTA; have a good standing in the clinical community; be able to contribute the required expertise for the task to be undertaken; and be able to convey the clear care delivery benefits of e-health and NEHTA’s work program to their peer network. The skills required of a clinical leader include:

• Tertiary qualifications in a clinical field with demonstrable clinical experience or understanding of in the Australian health sector;
• Membership of professional clinical organisations such as the relevant Royal College;
• Exposure to or an understanding of the e-health benefits to care delivery;
• Previous experience as an advocate for clinicians, e-health and/or healthcare reform;
• Ability to identify mechanisms for successful engagement and approaches for dissemination of NEHTA information to clinical audiences;
• Experience with and an ability to influence positive coverage of NEHTA’s work various organisations, professional bodies, Royal Colleges and clinical opinion makers including the media (in particular outside the specialist IT press);
• Ability to influence key clinical stakeholders and opinion makers; and
• Previous experience with representing the clinical requirements in projects by providing clinical involvement as a credible practicing clinician.

Scope of Work

The clinical leaders program will include a variety of clinicians with a range of skills and experience, to ensure that there is appropriate coverage for all tasks.

Some clinicians will be engaged on an as-required basis (for example, to participate in a one-off workshop on the implications of NEHTA’s discharge summary on clinical processes within hospitals). Others will be engaged on a part-time basis over a defined period of time on a specific task (for example, to work with NEHTA staff to review and provide clinical feedback at each stage of development of NEHTA’s pathology package; or to liaise with representatives from the Australian General Practice Network on aspects of NEHTA’s National Authentication Service for Health).

End NEHTA Text

First I guess we should all be grateful that four years after it was started NEHTA has finally noticed it is rather devoid of any real understanding as to how its principal client – the Australian Health Sector – actually operates and what it needs

This said the request for help seems to me to be wrong at an amazing number of cultural levels and to be going about what it wants to achieve entirely the wrong way.

For me the first big surprise is that they say they have decided they need a “Clinical Team” to assist them with Health Reform through the development of a national e-health system.

This statement triggers in me a range of questions like: What national e-health system? Who asked NEHTA to develop it? What will this new system look like, what will it cost etc etc. Is this just a slip of wording or have NEHTA developed some serious delusions of importance and grandeur.

Of course it will not have escaped regular readers this is to be an national e-health system developed by NEHTA and presumably Medicare Australia ably assisted by some part-time clinicians in the absence of an overarching strategy and plan. Good grief!

Second it is clear from the above NEHTA is seeking to shore up its influence and power by asking some clinicians to assist in the communication of their particular spin on things.

These paragraphs shows what is really desired from ‘clinician engagement’:

“Act as an advocate for NEHTA’s work on clinical issues, under the direction of NEHTA, with key clinical, jurisdiction, vendor and health consumer stakeholders including professional bodies, Royal Colleges, clinical opinion makers and the media”;

“Experience with and an ability to influence positive coverage of NEHTA’s work various organisations, professional bodies, Royal Colleges and clinical opinion makers including the media (in particular outside the specialist IT press);”

“Ability to influence key clinical stakeholders and opinion makers;”

NEHTA still wants to be the old controlling authority freak we have all come to know and love.

Third it seems to me that what NEHTA actually needs is a cultural infusion of Health Sector values and priorities. Hiring a few part time clinicians may help – but not as much as actually hiring some real ‘health informaticians’ to be fully embedded in each of the major work streams to provide the ongoing input, support and clinical understanding that NEHTA so badly needs. Pity they are all leaving in droves as they realise what a poor employer NEHTA is!

Fourth what NEHTA probably doesn’t understand is that any active clinician who is influential enough to be able to help is not going to work “under the direction” of anyone. These people have professional reputations that NEHTA can’t afford I believe. They will insist on the freedom to do as they see best – not take “direction”!

Fifth I find it interesting that NEHTA is not prepared to come out and say they mostly actually want senior doctors rather than senior clinicians. As much as other groups may deny it – the senior medical professionals are still the key determinants of what happens in the health sector. I have yet to see any substantive change in the sector be achieved without medical profession support or at the very least passive acceptance. (Just a bit PC I guess! – Membership of Royal Colleges is the giveaway in the qualification list!). Having ignored both doctors and virtually all other clinical profession for the last four years there is a fair bit of ground to make up!

Last it is interesting to see how NEHTA is framing their current work-plan and how – somehow - the Shared EHR is not any longer on the top level list. Wonder what that means?

My take. This is much too little and it is much too late!

David.

Southern Health (Victoria) Staff Speak Out on HealthSMART.

The following rather long letter arrived – by post – in an unmarked envelope – last week.

The impassioned three page letter (scanned) can be accessed here.

http://moreassoc.com.au/downloads/SH%20Letter%20Jan%2031%202008.pdf

(Note the file is about 3.0 Megs and takes a few moments to load even on a broadband link)

While it is hard to know the exact truth behind all these claims enough of the thrust of what is being said makes very good sense, and to me the broad points ring true.

The three articles cited can all be found on the e-Health-Media Website.

The URLs are:

http://www.e-health-insider.com/news/3427/full_lorenzo_benefits_expected_2012

http://www.e-health-insider.com/news/3364/csc_fined_%C2%A35m_for_late_delivery_of_pas_systems

and

http://www.e-health-insider.com/news/3351/cameron_says_nhs_it_must_be_local

Leaving totally aside the specific claims being made about the respective Health IT Vendors (which may or may not be in any way justified) there are a few generic points being made which I believe need careful consideration and discussion by those managing HealthSmart.

The first is that to have even a small number of individuals sufficiently concerned to write to the State Auditor-General (and simultaneously express concerns for the job security for speaking out) strongly suggests there are some serious communication and consultation problems in the HealthSmart programme.

The second is that, as the UK Connecting for Health Project has learned at some cost, rigid national or state implementations virtually inevitably incite major resistance. This is almost certainly due, in my view, to the fact that despite apparent homogeneity within the various entities in these Health Systems, there are in fact wide variations in work practices and processes. To not recognise and adapt to these – as a centralised implementation approach does not – is perilous indeed.

The third is that if a ‘best of breed’ application selection approach is adopted then effective seamless interfacing and integration is vital. This does not seem to have occurred here.

Fourth you cannot expect hospital staff to work to implement one system while being told in that in a few years time you will have to do it all again when the new model arrives. This guarantees staff alienation.

On the basis of this letter I suspect HealthSmart needs to quickly smarten itself up (pun intended) and look to start effective discussion and dialog with those involved.

I think the Department of Human Services (DHS) should treat this letter as a ‘sentinel event’ and that it should prompt a careful review of what is happening that is creating this level of concern among some of its employees. Additionally, for people to be nervous about alerting DHS to problems, for fear of retribution, is a very, very sad state of affairs.

I look forward to the odd comment from those south of the border in Victoria.

David.