In the last week I have come across a few reports and news items which are worth passing on. These include:
First is the site established by HealthCareIT News to cover activities in the National Health Information Network (NHIN) Arena.
The site can be found at:
http://www.nhinwatch.com/index.cms
The site has an impressive range of coverage on the whole area and a lot of current news and resources. Among the areas covered are
• Federal Initiatives
• Privacy and Security
• The Business Case
• NHIN Architecture
• RHIOs
• Voice and Data Networks
• Events
The site requires one time registration for access to a wide range of resources and interesting news including an RSS Feed.
The site describes itself as follows:
“About NHINWatch.com
Brought to you by the editors of Healthcare IT News, NHINWatch.com is the most comprehensive Web site covering the creation of a Nationwide Health Information Network in the United States.
During his tenure as the first National Health Information Technology Coordinator, David J. Brailer, MD, made the development of a NHIN the centerpiece of his plans to bring American healthcare into the 21st century. Based on feedback received from the industry, Dr. Brailer described the network as an Internet-based data exchange that would allow medical providers to share health data to improve care.
But in 2006, Dr. Brailer resigned from his post with many decision about the NHIN yet to be made. Will it require a national database of patient records? Will every patient need a national identifier, or will a federated system of identity management based on existing demographic data and record locator services suffice? How will privacy be protected?
Every day, the editorial team from the industry's leading and most trusted news source, Healthcare IT News, scours the wires for the latest developments. If there's a story on the NHIN, you'll find it here.
To stay abreast of NHIN developments, please take a moment to register. As a registered user, you'll be able to browse the growing collection of news, resources and events here at NHINWatch.com. You can also subscribe to NHINWatch.com newsletters to have the latest news delivered directly to your inbox, and configure the NHINWatch.com site to present stories that best match your topical interests.”
The second item is a really good news story from e-Health Insider.
http://www.e-health-insider.com/news/item.cfm?ID=2590
PACS roll-out milestone hit in London and the South
03 Apr 2007
All NHS hospital trusts across London and the South of England have now received systems to enable them to capture and store digital diagnostic images as part of the health service IT modernisation programme.
NHS Connecting for Health, the agency responsible for NHS IT, yesterday confirmed to E-Health insider that 56 digital picture archiving and communications systems (PACS) have now been installed in the past two years, covering all hospital trusts in the capital and South of England.
Prior to the NHS IT programme 18 trusts in the two regions had already put in PACS systems, taking the total number of installations to 74.
…..
The full article can be read at the site. This is really good news and the reactions of the users of these system reported by e-Health Insider offer considerable hope for other aspects of the Connecting for Health Program in the UK.
The third item is a tale of unintended consequences.
http://www.washingtonpost.com/wp-dyn/content/article/2007/04/04/AR2007040401935.html
“CAD Mammograms Often Find Harmless Spots
By JEFF DONN
The Associated Press
Wednesday, April 4, 2007; 10:56 PM
BOSTON -- A good mammogram reader may do just as well at spotting cancers without expensive new computer systems often used for a second opinion, a new study suggests. Computerized mammography, now used for about a third of the nation's mammograms, too often finds harmless spots that lead to false scares, researchers found. That conflicts with earlier studies showing benefit from the systems.”
…..
It seems clear that while the technology to analyse mammograms is more sensitive than the simple careful visual inspection of the mammogram it also results in many more women needing invasive biopsies and so on – meaning much more worry and anxiety for many women and little, if any benefit. As the article puts it, summarising the New England Journal of Medicine report:
“The researchers in this five-year study _ backed by the federal government and the American Cancer Society _ analyzed mammograms from medical centers in Washington state, Colorado and New Hampshire. Seven of 43 centers used CAD. The mammograms came from 222,135 women and included 2,351 with a cancer diagnosis within a year of their tests.
The researchers found that with computerized mammography, a third more women were called back for suspicious findings and 20 percent more got biopsies than with ordinary mammograms. That might be a good thing, if enough cancers turned up to justify the minor surgeries and anxiety surrounding them.
Yet the computerized method showed no clear capability to turn up more cancer cases than unaided readings: Four cancers were found for every 1,000 mammograms, whatever screening method was used. That means that CAD would give 156 more unneeded callbacks and 14 more biopsies for every additional cancer it finds. And though these extra cancers tend to be early ones that are easier to treat, many would never be threatening anyway.”
…..
The lesson here is that adoption of any technology without understanding the full impact it has on patient outcomes is always risky and that trials of technology need to assess the full impact on patient care – not just an improved number of cases located.
The last report this week is of very considerable concern:
http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070406/FREE/70405006/1029/FREE
“Quality chasm still exists: study
By: Joseph Conn / HITS staff writer
Story posted: April 6, 2007 - 6:00 am EDT
The more things change, well, you know the rest, even without reading the Fourth Annual Patient Safety in American Hospitals Study released this week by hospital report-card compiler HealthGrades.
"I think the bottom line is the quality chasm still exists between the top and bottom hospitals on the 13 quality indicators we compare," said Samantha Collier, the physician senior vice president of medical affairs and chief medical officer of the Golden, Colo.-based research company. "I think there is a significant gap, almost a 40% lower incident rate of these types of errors that we measured in the best performing hospitals to the lowest performing."
…..
The observation of a 40% difference in error rates makes it absolutely clear some hospitals are not trying hard enough. The impact of this being addressed:
“If all hospitals performed at the level of the top 15% in the study, which HealthGrades deems to be "Distinguished Hospitals for Patient Safety," there would have been 206,286 fewer patient safety incidents to Medicare patients, 34,393 fewer deaths and an estimated $1.74 billion would have been saved, according to Collier.”
…..
It would be good if statistics of the sort produced by HealthGrades were available in Australia so the debate on how to fix our hospitals could begin.
The full report can be read here:
http://www.healthgrades.com/media/dms/pdf/PatientSafetyInAmericanHospitalsStudy2007.pdf
A sobering read, as is the very good summary article I have quoted from.
David.
Monday, April 09, 2007
Tuesday, April 03, 2007
The 2007 AusHealthIT Blog “Looney Health IT Awards”
In the Spirit of April Fool's Day for 2007 the AusHealthIT blog felt it would be useful to award the “Blog Looney Health IT Awards” or BLHITAs – pronounced Blights (as in “Blight on the Landscape”)
Please hand over the envelopes, and to a drum roll, we announce the following awards:
The Grand Blight for 2007 goes to the Commonwealth Department of Health and Ageing (DoHA) – for managing to totally lose control of the National E-Health Agenda and for failing to ensure Australia has a National E-Health Strategy that the overall health system understands and supports.
The State Blight Award was shared in 2007 between NSW and South Australia. NSW earned its award for failing to recognise the importance of ensuring proper privacy standards in an e-Health Implementation (HealtheLink). South Australia achieved its award for its 'back to front' approach to system procurement where it plans to issue a tender for a Care Planning System before having even an interim evaluation of a Pilot Project.
The Stealth Blight Award for excessive discretion and information retention in the e-Health Domain is shared between DoHA and NEHTA. They both appear obsessed with unnecessary confidentiality / secrecy. DoHA wins the award for re-constituting the Australian Health Information Council without letting the public know. Even after two meetings those interested in these matters do not know who its members are, what they are doing and what their terms of reference are. NEHTA wins for its continuing use of stealth committees and consultants to provide it with advice rather than using the more traditional consultative processes when issues are of significant public interest and deserve transparent handling. DoHA also get a second dishonourable mention for its failure to report on the evaluation outcomes of the Eastern Goldfields Broadband Trial in Western Australia. A lot of public money went into that trial – and what do we hear of the outcomes – zip!
The “Can't See the Wood for the Trees” Blight is awarded to NEHTA for planning to allocate citizens a health identifier based on numbers allocated by Medicare Australia (which is part of the Department of Human Services) instead of using the identifier provided by the Access Card Division of the same department which is doing much the same thing. Worse, NEHTA claims the two projects don't intersect even though the major role of the Access Card is to replace the Medicare Card.
The “Creative Denial of Reality” Blight is awarded to DoHA for continuing to pretend there is any life in – or plans to seriously invest in – HealthConnect. SA Health are runner up for never explaining – when asked on the blog in public - how the security controls on their OACIS systems provide the level of security granularity and control most South Australians would expect.
The “Exaggeration of Importance of Influence” Blight is awarded to NEHTA for seemingly imagining it has the same level of influence (and is delivering as effectively) on the global E-Health stage as The US ONCHIT, The UK Connecting for Health Program and Canada's Health Infoway. The decision for HL7 last week – following the US, UK, Canada, Holland and Denmark makes it perfectly we are peripheral at best – and the delay in decision making confirms us as a ‘slow follower’ not a ‘fast follower’ as some have misguidedly claimed.
The “Tolerance in the Face of Extreme Provocation” Blight (or maybe it is an Anti-Blight) is awarded to the members of all the IT-14 Committees of Standards Australia for continuing to contribute despite a considerable level of side-lining, rail-roading and provocation by all sorts of external forces.
The “Failure to Grasp The Place of Health IT in the Health Sector” Blight goes to the proponents of Shared EHRs for attempting to progress projects of this type without continuing an in-depth public consultation with the total Australian Health Sector especially around the issues of privacy, consent, decision support and the location of functionality. This dooms them to failure I believe.
The “Silliest E-Health Presentation of the Year” Blight goes to NEHTA for suggesting there is $50+ Billion in benefits in health IT available without laying out what will be invested in to harvest these benefits and who will pay. Without a clear presentation of all the assumptions underlying these “models” it is just fantasy. It all may be true the case for major investment in Health IT is true (indeed I believe it is) – but how can anyone know without all the information? To publish half complete material like this just damages the credibility of those who work in the field in the eyes of the economic 'hard heads', who will not invest unless the full case is presented and is compelling.
The “Most Prolonged Gestation of an e-Health Concept” Blight is awarded to the proponents of the concept of archetypes for failing to explain, despite repeated requests from those who are somewhat sceptical, just how archetypes will be sustainably managed through their various versions, multiple iterations and inevitably large numbers over time. Just how the required infrastructure will be developed, funded, governed and supported into the future must be explained before archetype based systems can evolve beyond being a R & D projects and implementation of very limited scope – albeit very interesting ones.
The “Life is Cheap” Blight for failure to appreciate the need to urgently move on deployment of proven technology is awarded to all those who see progress in this area as a job rather than a passion and feel unnecessary deaths and suffering is not their problem. This Blight is shared with the Western Australian Health Department which also appears to have a very relaxed time-line in proceeding with updating the (presently quite limited) Health IT in that State.
All in all a sad list. I hope it might be better next April. All the points raised here can and should be addressed by those responsible and none are ‘rocket science’. I wonder what progress we might see.
For the sake of balance I am currently developing a list of awards for Health IT Stars (HITS). HITS will be awarded for exceptional contributions and efforts in a positive direction in e-Health. Nominations are welcome either as a comment or by e-mail. Please let me know about anything you know that seems to be useful, valuable and making a difference. I hope we can find a reasonable list.
David.
Please hand over the envelopes, and to a drum roll, we announce the following awards:
The Grand Blight for 2007 goes to the Commonwealth Department of Health and Ageing (DoHA) – for managing to totally lose control of the National E-Health Agenda and for failing to ensure Australia has a National E-Health Strategy that the overall health system understands and supports.
The State Blight Award was shared in 2007 between NSW and South Australia. NSW earned its award for failing to recognise the importance of ensuring proper privacy standards in an e-Health Implementation (HealtheLink). South Australia achieved its award for its 'back to front' approach to system procurement where it plans to issue a tender for a Care Planning System before having even an interim evaluation of a Pilot Project.
The Stealth Blight Award for excessive discretion and information retention in the e-Health Domain is shared between DoHA and NEHTA. They both appear obsessed with unnecessary confidentiality / secrecy. DoHA wins the award for re-constituting the Australian Health Information Council without letting the public know. Even after two meetings those interested in these matters do not know who its members are, what they are doing and what their terms of reference are. NEHTA wins for its continuing use of stealth committees and consultants to provide it with advice rather than using the more traditional consultative processes when issues are of significant public interest and deserve transparent handling. DoHA also get a second dishonourable mention for its failure to report on the evaluation outcomes of the Eastern Goldfields Broadband Trial in Western Australia. A lot of public money went into that trial – and what do we hear of the outcomes – zip!
The “Can't See the Wood for the Trees” Blight is awarded to NEHTA for planning to allocate citizens a health identifier based on numbers allocated by Medicare Australia (which is part of the Department of Human Services) instead of using the identifier provided by the Access Card Division of the same department which is doing much the same thing. Worse, NEHTA claims the two projects don't intersect even though the major role of the Access Card is to replace the Medicare Card.
The “Creative Denial of Reality” Blight is awarded to DoHA for continuing to pretend there is any life in – or plans to seriously invest in – HealthConnect. SA Health are runner up for never explaining – when asked on the blog in public - how the security controls on their OACIS systems provide the level of security granularity and control most South Australians would expect.
The “Exaggeration of Importance of Influence” Blight is awarded to NEHTA for seemingly imagining it has the same level of influence (and is delivering as effectively) on the global E-Health stage as The US ONCHIT, The UK Connecting for Health Program and Canada's Health Infoway. The decision for HL7 last week – following the US, UK, Canada, Holland and Denmark makes it perfectly we are peripheral at best – and the delay in decision making confirms us as a ‘slow follower’ not a ‘fast follower’ as some have misguidedly claimed.
The “Tolerance in the Face of Extreme Provocation” Blight (or maybe it is an Anti-Blight) is awarded to the members of all the IT-14 Committees of Standards Australia for continuing to contribute despite a considerable level of side-lining, rail-roading and provocation by all sorts of external forces.
The “Failure to Grasp The Place of Health IT in the Health Sector” Blight goes to the proponents of Shared EHRs for attempting to progress projects of this type without continuing an in-depth public consultation with the total Australian Health Sector especially around the issues of privacy, consent, decision support and the location of functionality. This dooms them to failure I believe.
The “Silliest E-Health Presentation of the Year” Blight goes to NEHTA for suggesting there is $50+ Billion in benefits in health IT available without laying out what will be invested in to harvest these benefits and who will pay. Without a clear presentation of all the assumptions underlying these “models” it is just fantasy. It all may be true the case for major investment in Health IT is true (indeed I believe it is) – but how can anyone know without all the information? To publish half complete material like this just damages the credibility of those who work in the field in the eyes of the economic 'hard heads', who will not invest unless the full case is presented and is compelling.
The “Most Prolonged Gestation of an e-Health Concept” Blight is awarded to the proponents of the concept of archetypes for failing to explain, despite repeated requests from those who are somewhat sceptical, just how archetypes will be sustainably managed through their various versions, multiple iterations and inevitably large numbers over time. Just how the required infrastructure will be developed, funded, governed and supported into the future must be explained before archetype based systems can evolve beyond being a R & D projects and implementation of very limited scope – albeit very interesting ones.
The “Life is Cheap” Blight for failure to appreciate the need to urgently move on deployment of proven technology is awarded to all those who see progress in this area as a job rather than a passion and feel unnecessary deaths and suffering is not their problem. This Blight is shared with the Western Australian Health Department which also appears to have a very relaxed time-line in proceeding with updating the (presently quite limited) Health IT in that State.
All in all a sad list. I hope it might be better next April. All the points raised here can and should be addressed by those responsible and none are ‘rocket science’. I wonder what progress we might see.
For the sake of balance I am currently developing a list of awards for Health IT Stars (HITS). HITS will be awarded for exceptional contributions and efforts in a positive direction in e-Health. Nominations are welcome either as a comment or by e-mail. Please let me know about anything you know that seems to be useful, valuable and making a difference. I hope we can find a reasonable list.
David.
NEHTA – What is the Status of All These Specifications?
In a very recent press release from NEHTA there is the following:
http://www.nehta.gov.au/index.php?option=com_content&task=view&id=182&Itemid=144
“NEHTA sets direction for electronic messaging in health
NEHTA confirms Health Level 7 as the national standard for the electronic messaging of health information across Australia.”
This set me to wonder, just where does NEHTA derive its authority to reach such conclusions? It is neither a government entity nor is it actually funded to make any product procurements which would seem to be the point at which what NEHTA wants and what the market has to offer intersect.
NEHTA's position would appear to be stated in the following terms (From the National E-Health Standards Development A Management Framework Version 1.0 – 15/03/2006):
“3.3 Compliance
NEHTA's role includes the development of specifications for inclusion in Government and potentially other health sector procurement processes. These specifications will be technical in nature, normative, and incorporated into commercial contracts.
On their own, standards or technical specifications have no legal status and are free to be followed or not by manufacturers, consumers or the public. However, if a Standard or specification is referenced in legislation, or written into a commercial contract, it becomes enforceable by virtue of that legislation or contract. When this happens, Standards become mandatory and their reasonableness, quality and impact can be subject to the scrutiny of the courts. Accordingly, standards development organisations make every attempt to ensure that the principles and processes used to develop standards are based on good practice.
In respect of “specifications” such as those produced by NEHTA, the WTO Agreement on Government Procurement states that:
“Technical specifications prescribed by procuring entities shall, where appropriate:
(a) be in terms of performance rather than design or descriptive characteristics; and
(b) be based on international standards, where such exist; otherwise, on national technical regulations, recognized national standards, or building codes.”
Further to this the Council of Australian Governments (COAG) recently committed to: “promoting compliance with nationally-agreed standards in future government procurements related to electronic health systems and in areas of healthcare receiving government funding.”
While not being a lawyer, this seems pretty clear to me. The key points are:
1. Standards and specifications only become enforceable if they are either legislated or become part of a commercial contract.
2. If they become part of legislation or a commercial contract they are testable by the courts for their “reasonableness, quality and impact”.
3. To be valid they must be developed by appropriate processes.
4. They should be performance based (i.e. lead to an outcome if adopted – e.g. a level of fire resistance of material which if used will save life or property or with e-health, for example, be demonstrably workable and able to be implemented)
5. Be based on international standards unless there are compelling gaps in what is available internationally which need to be filled.
Most important, it seems to me, is the quality and depth of the development processes.
Standards Australia summarises the process needs very succinctly.
http://www.standards.org.au/cat.asp?catid=6
“Cardinal Principles of Australian Standardisation
Open
Any affected or interested representative organisation has the opportunity to participate.
Balanced
The committee shall be balanced and not dominated by any single interest category or organisation.
Due Process
All valid objections shall have an attempt made towards achieving resolutions.
Consensus
More than a majority but not necessarily unanimity.”
Standards Australia also succinctly summarises the legal status of their work as they see it:
http://www.standards.org.au/cat.asp?catid=7
“The legal status of Australian Standards®
Standards Australia is an independent organisation and our Standards are not legal documents. However, because of their convenience and the willingness of all parties to adopt them, many of the documents are called up in Federal or State legislation, with the result that they then become mandatory. Currently about 2400 of our Standards are mandatory, however most are used voluntarily by people who value their expertise and commonsense. They are practical and don't set impossible goals. They are based on sound industrial and scientific experience. And, because they are regularly revised, they keep pace with new technologies.”
It is interesting that much of the spirit of this is captured in the NEHTA Standards Development Framework document. However, I think there are many who think NEHTA's compliance with the requirements for openness, balance, due process and consensus is yet to be seen.
Equally the comments from Standards Australia on the need for practicality and the use of experience seem highly appropriate – and these have yet to really be taken to heart by NEHTA.
It is also interesting that after operating for over two years NEHTA finally perceived that it needed a formal documented relationship with Standards Australia on February 9 this year. See
http://www.nehta.gov.au/index.php?option=com_content&task=view&id=178&Itemid=144
I also find it fascinating that as of February 2, 2007 NEHTA can say – in the description of the document entitled “Supporting National E-Health Standards Implementation v1.0” the following.
“The consistent implementation of health informatics standards is critical to achieving an information technology enabled health sector within Australia. The structure of the health system in Australia is diverse and dynamic, which does not readily support standards implementation. To achieve the e-health goals for Australia it is necessary to address the current challenges associated with standards implementation.
The purpose of this document is to provide guidance to those in the health sector responsible for improving care delivery through information technology by identifying some of the challenges to health informatics standards implementation; defining adoption, uptake and implementation; and clarifying the strategies and activities that will assist in resolving the challenges. A framework to support successful standards implementation is also described.
This document completes the development of NEHTA's National E-Health Standards Plan.”
What is being said here, as I read it is:
1. This is all very hard (or, we think we need help, but who can help us?)
2. Someone – i.e. you out there - have to address the challenges it poses (or, we can only tell you what to do but you have to do it and make it work)
3. Here is a document to tell you how – with such memorable quotes as “The onset of e-health breeds confusion due to fear, uncertainty and doubt.[5]” – Page 6. (or, is it any wonder we are confused?)
4. We have done all we can – so over to you (or, we hope we’ve helped, good luck in your future endeavours).
Surely something as basic as a Standards Plan needs to be a living, developing, learning document – not a fait accompli.
That many in the Health IT industry are only reading NEHTA's documents “when there is nothing more useful to do” seems a valid approach to be adopting until the NEHTA processes move to a more appropriate level of consensus creation, communication and consultation.
It seems to me NEHTA has to do a much better job of explaining to the Health IT community the value and usefulness of their efforts for them to have much real impact and that pretending (with the words quoted in the compliance area above) they have legal enforceability on their side is probably little more than a rather pathetic bluff.
NEHTA does not have legislated authority and their specifications and recommendations are not the product of a recognisable standards creation process as they are traditionally undertaken.
For NEHTA to ever be really relevant a lot needs to change – and soon.
David.
http://www.nehta.gov.au/index.php?option=com_content&task=view&id=182&Itemid=144
“NEHTA sets direction for electronic messaging in health
NEHTA confirms Health Level 7 as the national standard for the electronic messaging of health information across Australia.”
This set me to wonder, just where does NEHTA derive its authority to reach such conclusions? It is neither a government entity nor is it actually funded to make any product procurements which would seem to be the point at which what NEHTA wants and what the market has to offer intersect.
NEHTA's position would appear to be stated in the following terms (From the National E-Health Standards Development A Management Framework Version 1.0 – 15/03/2006):
“3.3 Compliance
NEHTA's role includes the development of specifications for inclusion in Government and potentially other health sector procurement processes. These specifications will be technical in nature, normative, and incorporated into commercial contracts.
On their own, standards or technical specifications have no legal status and are free to be followed or not by manufacturers, consumers or the public. However, if a Standard or specification is referenced in legislation, or written into a commercial contract, it becomes enforceable by virtue of that legislation or contract. When this happens, Standards become mandatory and their reasonableness, quality and impact can be subject to the scrutiny of the courts. Accordingly, standards development organisations make every attempt to ensure that the principles and processes used to develop standards are based on good practice.
In respect of “specifications” such as those produced by NEHTA, the WTO Agreement on Government Procurement states that:
“Technical specifications prescribed by procuring entities shall, where appropriate:
(a) be in terms of performance rather than design or descriptive characteristics; and
(b) be based on international standards, where such exist; otherwise, on national technical regulations, recognized national standards, or building codes.”
Further to this the Council of Australian Governments (COAG) recently committed to: “promoting compliance with nationally-agreed standards in future government procurements related to electronic health systems and in areas of healthcare receiving government funding.”
While not being a lawyer, this seems pretty clear to me. The key points are:
1. Standards and specifications only become enforceable if they are either legislated or become part of a commercial contract.
2. If they become part of legislation or a commercial contract they are testable by the courts for their “reasonableness, quality and impact”.
3. To be valid they must be developed by appropriate processes.
4. They should be performance based (i.e. lead to an outcome if adopted – e.g. a level of fire resistance of material which if used will save life or property or with e-health, for example, be demonstrably workable and able to be implemented)
5. Be based on international standards unless there are compelling gaps in what is available internationally which need to be filled.
Most important, it seems to me, is the quality and depth of the development processes.
Standards Australia summarises the process needs very succinctly.
http://www.standards.org.au/cat.asp?catid=6
“Cardinal Principles of Australian Standardisation
Open
Any affected or interested representative organisation has the opportunity to participate.
Balanced
The committee shall be balanced and not dominated by any single interest category or organisation.
Due Process
All valid objections shall have an attempt made towards achieving resolutions.
Consensus
More than a majority but not necessarily unanimity.”
Standards Australia also succinctly summarises the legal status of their work as they see it:
http://www.standards.org.au/cat.asp?catid=7
“The legal status of Australian Standards®
Standards Australia is an independent organisation and our Standards are not legal documents. However, because of their convenience and the willingness of all parties to adopt them, many of the documents are called up in Federal or State legislation, with the result that they then become mandatory. Currently about 2400 of our Standards are mandatory, however most are used voluntarily by people who value their expertise and commonsense. They are practical and don't set impossible goals. They are based on sound industrial and scientific experience. And, because they are regularly revised, they keep pace with new technologies.”
It is interesting that much of the spirit of this is captured in the NEHTA Standards Development Framework document. However, I think there are many who think NEHTA's compliance with the requirements for openness, balance, due process and consensus is yet to be seen.
Equally the comments from Standards Australia on the need for practicality and the use of experience seem highly appropriate – and these have yet to really be taken to heart by NEHTA.
It is also interesting that after operating for over two years NEHTA finally perceived that it needed a formal documented relationship with Standards Australia on February 9 this year. See
http://www.nehta.gov.au/index.php?option=com_content&task=view&id=178&Itemid=144
I also find it fascinating that as of February 2, 2007 NEHTA can say – in the description of the document entitled “Supporting National E-Health Standards Implementation v1.0” the following.
“The consistent implementation of health informatics standards is critical to achieving an information technology enabled health sector within Australia. The structure of the health system in Australia is diverse and dynamic, which does not readily support standards implementation. To achieve the e-health goals for Australia it is necessary to address the current challenges associated with standards implementation.
The purpose of this document is to provide guidance to those in the health sector responsible for improving care delivery through information technology by identifying some of the challenges to health informatics standards implementation; defining adoption, uptake and implementation; and clarifying the strategies and activities that will assist in resolving the challenges. A framework to support successful standards implementation is also described.
This document completes the development of NEHTA's National E-Health Standards Plan.”
What is being said here, as I read it is:
1. This is all very hard (or, we think we need help, but who can help us?)
2. Someone – i.e. you out there - have to address the challenges it poses (or, we can only tell you what to do but you have to do it and make it work)
3. Here is a document to tell you how – with such memorable quotes as “The onset of e-health breeds confusion due to fear, uncertainty and doubt.[5]” – Page 6. (or, is it any wonder we are confused?)
4. We have done all we can – so over to you (or, we hope we’ve helped, good luck in your future endeavours).
Surely something as basic as a Standards Plan needs to be a living, developing, learning document – not a fait accompli.
That many in the Health IT industry are only reading NEHTA's documents “when there is nothing more useful to do” seems a valid approach to be adopting until the NEHTA processes move to a more appropriate level of consensus creation, communication and consultation.
It seems to me NEHTA has to do a much better job of explaining to the Health IT community the value and usefulness of their efforts for them to have much real impact and that pretending (with the words quoted in the compliance area above) they have legal enforceability on their side is probably little more than a rather pathetic bluff.
NEHTA does not have legislated authority and their specifications and recommendations are not the product of a recognisable standards creation process as they are traditionally undertaken.
For NEHTA to ever be really relevant a lot needs to change – and soon.
David.
Sunday, April 01, 2007
Interesting Newly Found e-Health Related Sites
A colleague has provided the following suggested site for all those interested in the use of Systems Methodologies to come to grips with the complexities of Health Service Delivery in the real world.
National Institutes for Health: Systems Methodologies for Solving Real-World Problems: Applications in Public Health Presented by: Patty Mabry, Ph.D., Bobby Milstein, Ph.D., M.P.H., John Sterman, Ph.D. and Ken McLeroy, Ph.D., Washington, March 2007
The Videocast is Described as follows:
“The first in a series of four educational seminars featuring leaders in various areas of systems science. The purposes are to raise awareness of particularly promising methodologies; and improve our collective understanding about how and when they may be used effectively by behavioural and social scientists (including researchers, policy analysts, planners/evaluators, grant reviewers, journal editors and government officials).
This first symposium provides an introduction to, and overview of, the rest of the series. The core principles of system-oriented inquiry will be described, while briefly surveying a variety of methodological traditions and emerging directions in the field. John Sterman (Director, System Dynamics Group at MIT) will share his view of the field followed by Ken McLeroy (Associate Dean at Texas A&M and Department Editor for AJPH), who will explore further implications and assess the prospects for incorporating systems methodologies more fully into routine public health work.
This is important material from some of the global experts in the field!
It is a large download – some 780 Megabytes – so be warned!
If interested in the area go to:
http://videocast.nih.gov/Summary.asp?file=13712
The following also seems to be very useful.
Learning from Mistakes
No news is said to be good news. For Scot Silverstein, M.D., however, lack of information is a symptom of a major industry problem. In 1998, Silverstein launched a Web site devoted to shining light on healthcare IT failures. Hospital leaders, IT vendors and the media have swept the topic under the rug, he says. “IT failure is a serious problem, but people are reluctant to study it,” says Silverstein, the director of the Philadelphia-based Institute for Healthcare Informatics at Drexel University College of Information Science and Technology. “We like to talk about success, not failure.”
According to Silverstein, the healthcare industry is plagued by projects that do not live up their potential—or in some cases, are scrapped altogether. His observations are drawn from several years of experience working at large health systems, where clinical documentation projects involving IT stalled due to mismanagement. In 1998, Silverstein launched the site, hoping to gather case studies from others in the field.
………
The site is: www.ischool.Drexel.edu/faculty/ssilverstein/medinfo.htm
—Gary Baldwin
The full article can be found at:
http://www.healthleadersmedia.com/magazine/view_magazine_feature.cfm?content_id=87842&category_id=155
Additionally – also important is this:
Proof of Impact: New Study Sheds Light on Economics of Health IT Investment
by Colleen Egan, iHealthBeat Editor
March 30, 2007
While many in the health care industry say that investment in IT leads to better quality and performance, there is a dearth of solid evidence to support that claim. A new report from PricewaterhouseCoopers aims to "retire the question of whether IT has a positive impact on hospital business performance."
The report, titled "The Economics of IT and Hospital Performance," used "econometric" techniques to study the relationship between IT adoption and organizational performance at nearly 2,000 U.S. hospitals over a five-year period. Researchers -- who used sources such as the Solucient ProviderView database and the American Hospital Association's Annual Survey Database -- collected three types of data:
• Hospital services and facilities utilization;
• Health IT investment; and
• Hospital operating costs.
……
The full article can be found at:
http://www.ihealthbeat.org/index.cfm?Action=dspItem&itemid=132349
Lastly:
Six tips for surefire EHR implementation success
Electronic Health Records Briefing, Mar. 27, 2007
Joel N. Diamond, MD, implemented an inpatient EHR, including 100 percent adoption of computerized physician order entry at the University of Pittsburgh Medical Center St. Margaret Memorial Hospital. This was one of the first successful community hospital installations in the United States.
Before launching CPOE in September 2004, Diamond went on a one-year campaign among St. Margaret’s 300 private physicians to promote acceptance of CPOE and identify those who resisted it. Because of this, the hospital launched the system two weeks ahead of schedule and now enjoys full participation by the medical staff. During the January 24 HealthLeaders Media (a division of HCPro, Inc.) Webcast “Bringing the Digital Hospital to Life: Expert advice and real-world lessons,” Diamond offered the following six tips for successful implementation:
……
Again the full article can be found at:
http://www.healthleadersmedia.com/view_content.cfm?content_id=88249
Enjoy!
David.
National Institutes for Health: Systems Methodologies for Solving Real-World Problems: Applications in Public Health Presented by: Patty Mabry, Ph.D., Bobby Milstein, Ph.D., M.P.H., John Sterman, Ph.D. and Ken McLeroy, Ph.D., Washington, March 2007
The Videocast is Described as follows:
“The first in a series of four educational seminars featuring leaders in various areas of systems science. The purposes are to raise awareness of particularly promising methodologies; and improve our collective understanding about how and when they may be used effectively by behavioural and social scientists (including researchers, policy analysts, planners/evaluators, grant reviewers, journal editors and government officials).
This first symposium provides an introduction to, and overview of, the rest of the series. The core principles of system-oriented inquiry will be described, while briefly surveying a variety of methodological traditions and emerging directions in the field. John Sterman (Director, System Dynamics Group at MIT) will share his view of the field followed by Ken McLeroy (Associate Dean at Texas A&M and Department Editor for AJPH), who will explore further implications and assess the prospects for incorporating systems methodologies more fully into routine public health work.
This is important material from some of the global experts in the field!
It is a large download – some 780 Megabytes – so be warned!
If interested in the area go to:
http://videocast.nih.gov/Summary.asp?file=13712
The following also seems to be very useful.
Learning from Mistakes
No news is said to be good news. For Scot Silverstein, M.D., however, lack of information is a symptom of a major industry problem. In 1998, Silverstein launched a Web site devoted to shining light on healthcare IT failures. Hospital leaders, IT vendors and the media have swept the topic under the rug, he says. “IT failure is a serious problem, but people are reluctant to study it,” says Silverstein, the director of the Philadelphia-based Institute for Healthcare Informatics at Drexel University College of Information Science and Technology. “We like to talk about success, not failure.”
According to Silverstein, the healthcare industry is plagued by projects that do not live up their potential—or in some cases, are scrapped altogether. His observations are drawn from several years of experience working at large health systems, where clinical documentation projects involving IT stalled due to mismanagement. In 1998, Silverstein launched the site, hoping to gather case studies from others in the field.
………
The site is: www.ischool.Drexel.edu/faculty/ssilverstein/medinfo.htm
—Gary Baldwin
The full article can be found at:
http://www.healthleadersmedia.com/magazine/view_magazine_feature.cfm?content_id=87842&category_id=155
Additionally – also important is this:
Proof of Impact: New Study Sheds Light on Economics of Health IT Investment
by Colleen Egan, iHealthBeat Editor
March 30, 2007
While many in the health care industry say that investment in IT leads to better quality and performance, there is a dearth of solid evidence to support that claim. A new report from PricewaterhouseCoopers aims to "retire the question of whether IT has a positive impact on hospital business performance."
The report, titled "The Economics of IT and Hospital Performance," used "econometric" techniques to study the relationship between IT adoption and organizational performance at nearly 2,000 U.S. hospitals over a five-year period. Researchers -- who used sources such as the Solucient ProviderView database and the American Hospital Association's Annual Survey Database -- collected three types of data:
• Hospital services and facilities utilization;
• Health IT investment; and
• Hospital operating costs.
……
The full article can be found at:
http://www.ihealthbeat.org/index.cfm?Action=dspItem&itemid=132349
Lastly:
Six tips for surefire EHR implementation success
Electronic Health Records Briefing, Mar. 27, 2007
Joel N. Diamond, MD, implemented an inpatient EHR, including 100 percent adoption of computerized physician order entry at the University of Pittsburgh Medical Center St. Margaret Memorial Hospital. This was one of the first successful community hospital installations in the United States.
Before launching CPOE in September 2004, Diamond went on a one-year campaign among St. Margaret’s 300 private physicians to promote acceptance of CPOE and identify those who resisted it. Because of this, the hospital launched the system two weeks ahead of schedule and now enjoys full participation by the medical staff. During the January 24 HealthLeaders Media (a division of HCPro, Inc.) Webcast “Bringing the Digital Hospital to Life: Expert advice and real-world lessons,” Diamond offered the following six tips for successful implementation:
……
Again the full article can be found at:
http://www.healthleadersmedia.com/view_content.cfm?content_id=88249
Enjoy!
David.
Thursday, March 29, 2007
What is NEHTA up to with Shared Electronic Health Records, HL7 and so on?
Last week we had the following announcement from NEHTA.
http://www.nehta.gov.au/index.php?option=com_content&task=view&id=182&Itemid=144
“NEHTA sets direction for electronic messaging in health
NEHTA confirms Health Level 7 as the national standard for the electronic messaging of health information across Australia.
Across the Australian healthcare sector there are many different types of computer software and systems that are involved in the exchange of information. Currently, these systems use various exchange formats to send and receive information. To ensure that all systems across Australia have the ability to reliably and safely communicate with each other, a standard exchange format is required. The National E-Health Transition Authority (NEHTA) has determined that this standard will be based on the HL7 family of standards.”
NEHTA's roadmap for deployment and adoption is outlined later in the press release:
“To assist the health IT sector to migrate to this standard, NEHTA has identified the following approach:
a. Where HL7 version 2.x standards are already extensively used and yielding benefits, for example pathology and patient administration, these standards should continue to be supported. Where HL7 standards are not in use, they should be factored into system upgrades where practicable.
b. NEHTA will now focus on developing Web services specifications based on work undertaken by the HL7 Services Specification Project (HSSP), and content specifications based on the HL7 Clinical Document Architecture – Release 2 (CDA R2) for areas such as referral, discharge, prescribing, dispensing and pathology.
c. This work will then form the basis by which industry will migrate to HL7 version 3.”
This is really quite a large ‘change’ or dare I say ‘leap’ for NEHTA – so large in fact that a search of NEHTA’s “National E-Health Standards Catalogue - Supporting Standards Implementation - Version 2.0 - 19/01/2007” (8 weeks ago) does not have a single reference to HL7!
This is actually quite surprising given that HL7 V2.x was recommended by DH4 for continued use by the Australian Health Sector over 12 months ago and indeed it is widely deployed and Standardised nationally.
What is of major concern is not that NEHTA can show flexibility, but that they can show so much flexibility in moving from their previously announced path to this current path so quickly. Quite frankly, to put it bluntly this is not how Standards Development Organisations – even amateur ones – should behave. Were I a Health IT developer who had invested time and money in responding to NEHTA's previous Generic SOA approaches I would surely be suggesting that I would like my money back (with interest)!
This kind of strategic instability reflects a serious lack of real industry consultation over the last three years. There should be some accountability moment or action associated with this switch.
It is also difficult to understand why in NEHTA’s document entitled “Guidelines for Implementing Interoperable Web Services Version 1.0 – 28 March 2007” there does not seem to be any mention of either HL7 or HSSP. A comment as to where this new direction for interoperability with HL7 and HSSP fitted with this implementation guideline would have been useful and informative to everyone!
Indeed the delay in coming to a view of the place of HL7, given the expertise and advice available to NEHTA, is really unconscionable and has been a major barrier to e-health progress. One could have expected strategic clarity in the area much before this.
One must also wonder with the decision to deploy content based on CDA R2 just where all the NEHTA Clinical Data Specification work fits and how much of this will need to be altered or reviewed to conform with the HL7 Reference Information Model? It would also be interesting to know how all this fits with the long delayed but imminent Shared EHR announcements.
A final point - does anyone else think making a decision like the HL7 decision warrant a process of open public discussion and not simply an ex-cathedra announcement. Some of us don't worship at that sort of church!
Talk of the right hand not knowing what the left hand is up to.
David.
http://www.nehta.gov.au/index.php?option=com_content&task=view&id=182&Itemid=144
“NEHTA sets direction for electronic messaging in health
NEHTA confirms Health Level 7 as the national standard for the electronic messaging of health information across Australia.
Across the Australian healthcare sector there are many different types of computer software and systems that are involved in the exchange of information. Currently, these systems use various exchange formats to send and receive information. To ensure that all systems across Australia have the ability to reliably and safely communicate with each other, a standard exchange format is required. The National E-Health Transition Authority (NEHTA) has determined that this standard will be based on the HL7 family of standards.”
NEHTA's roadmap for deployment and adoption is outlined later in the press release:
“To assist the health IT sector to migrate to this standard, NEHTA has identified the following approach:
a. Where HL7 version 2.x standards are already extensively used and yielding benefits, for example pathology and patient administration, these standards should continue to be supported. Where HL7 standards are not in use, they should be factored into system upgrades where practicable.
b. NEHTA will now focus on developing Web services specifications based on work undertaken by the HL7 Services Specification Project (HSSP), and content specifications based on the HL7 Clinical Document Architecture – Release 2 (CDA R2) for areas such as referral, discharge, prescribing, dispensing and pathology.
c. This work will then form the basis by which industry will migrate to HL7 version 3.”
This is really quite a large ‘change’ or dare I say ‘leap’ for NEHTA – so large in fact that a search of NEHTA’s “National E-Health Standards Catalogue - Supporting Standards Implementation - Version 2.0 - 19/01/2007” (8 weeks ago) does not have a single reference to HL7!
This is actually quite surprising given that HL7 V2.x was recommended by DH4 for continued use by the Australian Health Sector over 12 months ago and indeed it is widely deployed and Standardised nationally.
What is of major concern is not that NEHTA can show flexibility, but that they can show so much flexibility in moving from their previously announced path to this current path so quickly. Quite frankly, to put it bluntly this is not how Standards Development Organisations – even amateur ones – should behave. Were I a Health IT developer who had invested time and money in responding to NEHTA's previous Generic SOA approaches I would surely be suggesting that I would like my money back (with interest)!
This kind of strategic instability reflects a serious lack of real industry consultation over the last three years. There should be some accountability moment or action associated with this switch.
It is also difficult to understand why in NEHTA’s document entitled “Guidelines for Implementing Interoperable Web Services Version 1.0 – 28 March 2007” there does not seem to be any mention of either HL7 or HSSP. A comment as to where this new direction for interoperability with HL7 and HSSP fitted with this implementation guideline would have been useful and informative to everyone!
Indeed the delay in coming to a view of the place of HL7, given the expertise and advice available to NEHTA, is really unconscionable and has been a major barrier to e-health progress. One could have expected strategic clarity in the area much before this.
One must also wonder with the decision to deploy content based on CDA R2 just where all the NEHTA Clinical Data Specification work fits and how much of this will need to be altered or reviewed to conform with the HL7 Reference Information Model? It would also be interesting to know how all this fits with the long delayed but imminent Shared EHR announcements.
A final point - does anyone else think making a decision like the HL7 decision warrant a process of open public discussion and not simply an ex-cathedra announcement. Some of us don't worship at that sort of church!
Talk of the right hand not knowing what the left hand is up to.
David.
Tuesday, March 27, 2007
An Even Better Use for the Future Fund Money.
It seems that the Labor Party recognises that there are some pieces of technical infrastructure that require an element of Government funding to bring into existence, but that once implemented there will be ongoing benefit for the nation.
The essence of their internet broadband announcement is as follows:
“Federal Labor will revolutionise Australia’s internet infrastructure by creating a new National Broadband Network.
It will connect 98 per cent of Australians to high speed broadband internet services – at speeds over 40 times faster than most current speeds.
With the rollout of a new ‘Fibre To The Node’ (FTTN) network, Federal Labor will increase speed to a minimum of 12 megabits per second – so fast that household entertainment, business communication and family services will happen in real time.
The remaining two per cent of Australians in regional and rural Australia not covered by the FTTN network will have improved broadband services.
New services and benefits of the network – particularly in rural and regional areas – include:
• Slashed telephone bills for small business;
• Enhanced business services such as teleconferencing, video conferencing and virtual private networks;
• Enhanced capacity for services like e-education and e-health; and
• High definition, multi-channel and inter-active TV services.
It is estimated that the new National Broadband Network will deliver national economic benefits including:
• Up to $30 billion in additional economic activity every year;
• Making Australian small businesses more competitive;
• Creating new markets for businesses and new jobs for Australians; and
• Extending media diversity.
A Rudd Labor Government will:
• Partner with the private sector to deliver the national broadband network over five years;
• Undertake a competitive assessment of proposals from the private sector to build the network;
• Ensure competition in the sector through an open access network that provides equivalence of access charges and scope for access seekers to differentiate their product offerings;
• Put in place regulatory reforms to ensure certainty for investment; and
• Make a public equity investment of up to $4.7 billion.
This commitment will be financed from existing government investment in communications, including the $2 billion Communications Fund and through the Future Fund’s 17 per cent share in Telstra, which will earn dividends and be sold down to a normal market level after November 2008.”
It seems to me this is just the first step. No point in having train lines (i.e. the broadband network) if you don’t have trains (e.g. e-health) to take advantage of it!
Given that there is a clear business case for increased spending in the Health IT domain – with net benefits estimated at up to $A5.0 Billion per annum or more (based on studies undertaken in the US, UK and Canada) what could be a better use of a little more of the Future Fund than to kick start e-health with an investment designed to deliver a real return once implemented?
A sensible approach would to be develop a National E-Health Strategy, Business Case and Implementation Plan as a first step and to then establish an highly accountable implementation organisation – maybe modelled on the UK or Canadian models or a mixture of the two – with a focus on making sure the lessons learnt from both are properly absorbed. (While I plan a separate article on this area in the future the need for local involvement, ownership and choice in the context or appropriate standardisation and central direction setting now seem obvious for any national initiative.)
The Future Fund has as its objective a return of 7.5% + inflation over the long term I understand. It would seem this return could be achieved with expert project management and the deployment of Health IT is a way that is known to have beneficial impacts (i.e. use of advanced clinical workstations, in depth automation of investigative services and supply chains, improved secure messaging and the use of systems wherever possible with advanced clinical decision support). Measurement and well as realization of the return on investment I recognise will be a considerable challenge but should not be impossible. There is no doubt the econometric tools exist to undertake such work exist.
The main issue that will almost certainly emerge will be how the benefits achieved will be cashed out for return to the Future Fund – given the tendency of the Health Sector to aim to expand services when efficiencies are obtained rather than take the cash benefit.
I believe the scale of the return on investment in this sector is likely to mean that both some service expansion as well as cashing out of benefits will be possible – to everyone’s pleasure.
Health IT is an ideal candidate for a major planned capital investment and will both make a profit and do good things for the users of, and workers in, the Health Sector.
Let’s give it very careful thought.
David.
The essence of their internet broadband announcement is as follows:
“Federal Labor will revolutionise Australia’s internet infrastructure by creating a new National Broadband Network.
It will connect 98 per cent of Australians to high speed broadband internet services – at speeds over 40 times faster than most current speeds.
With the rollout of a new ‘Fibre To The Node’ (FTTN) network, Federal Labor will increase speed to a minimum of 12 megabits per second – so fast that household entertainment, business communication and family services will happen in real time.
The remaining two per cent of Australians in regional and rural Australia not covered by the FTTN network will have improved broadband services.
New services and benefits of the network – particularly in rural and regional areas – include:
• Slashed telephone bills for small business;
• Enhanced business services such as teleconferencing, video conferencing and virtual private networks;
• Enhanced capacity for services like e-education and e-health; and
• High definition, multi-channel and inter-active TV services.
It is estimated that the new National Broadband Network will deliver national economic benefits including:
• Up to $30 billion in additional economic activity every year;
• Making Australian small businesses more competitive;
• Creating new markets for businesses and new jobs for Australians; and
• Extending media diversity.
A Rudd Labor Government will:
• Partner with the private sector to deliver the national broadband network over five years;
• Undertake a competitive assessment of proposals from the private sector to build the network;
• Ensure competition in the sector through an open access network that provides equivalence of access charges and scope for access seekers to differentiate their product offerings;
• Put in place regulatory reforms to ensure certainty for investment; and
• Make a public equity investment of up to $4.7 billion.
This commitment will be financed from existing government investment in communications, including the $2 billion Communications Fund and through the Future Fund’s 17 per cent share in Telstra, which will earn dividends and be sold down to a normal market level after November 2008.”
It seems to me this is just the first step. No point in having train lines (i.e. the broadband network) if you don’t have trains (e.g. e-health) to take advantage of it!
Given that there is a clear business case for increased spending in the Health IT domain – with net benefits estimated at up to $A5.0 Billion per annum or more (based on studies undertaken in the US, UK and Canada) what could be a better use of a little more of the Future Fund than to kick start e-health with an investment designed to deliver a real return once implemented?
A sensible approach would to be develop a National E-Health Strategy, Business Case and Implementation Plan as a first step and to then establish an highly accountable implementation organisation – maybe modelled on the UK or Canadian models or a mixture of the two – with a focus on making sure the lessons learnt from both are properly absorbed. (While I plan a separate article on this area in the future the need for local involvement, ownership and choice in the context or appropriate standardisation and central direction setting now seem obvious for any national initiative.)
The Future Fund has as its objective a return of 7.5% + inflation over the long term I understand. It would seem this return could be achieved with expert project management and the deployment of Health IT is a way that is known to have beneficial impacts (i.e. use of advanced clinical workstations, in depth automation of investigative services and supply chains, improved secure messaging and the use of systems wherever possible with advanced clinical decision support). Measurement and well as realization of the return on investment I recognise will be a considerable challenge but should not be impossible. There is no doubt the econometric tools exist to undertake such work exist.
The main issue that will almost certainly emerge will be how the benefits achieved will be cashed out for return to the Future Fund – given the tendency of the Health Sector to aim to expand services when efficiencies are obtained rather than take the cash benefit.
I believe the scale of the return on investment in this sector is likely to mean that both some service expansion as well as cashing out of benefits will be possible – to everyone’s pleasure.
Health IT is an ideal candidate for a major planned capital investment and will both make a profit and do good things for the users of, and workers in, the Health Sector.
Let’s give it very careful thought.
David.
Monday, March 26, 2007
It's Nice to See The System Working!
This arrived today via Her Majesty's Post in response to my open letter of a week or so back.
Next step is to see what the Department's officers make of the suggestions and comments to be found here!
I wait with bated breath.
David.
Next step is to see what the Department's officers make of the suggestions and comments to be found here!
I wait with bated breath.
David.
Sunday, March 25, 2007
Imminent Fiasco Alert – SA HealthConnect running off the Rails.
I suspect there must be something in the water that reaches
For background on this project go to my post of late last year.
http://aushealthit.blogspot.com/2006/12/children-of-healthconnect-how-are-they.html
The Table of Project Activities says it all! What is described in the table is an absolute and incompetent disgrace which is even worse than some of the bungled HealthConnect trials of years gone by. It is chaotic and absurd in the way it is being organised and the table of activities shows those involved have no idea what they are doing. Just consider the following past and future sequences carefully.
--------------------------------------------------------------------------------------
February 2006 - Functional specification drafted
July 2006 - Care Planning Trial commenced
October 2006 - Commenced consultations with NEHTA re standards and data specifications and local groups, e.g. Health Provider Index (ongoing)
November 2006 - Care Planning Trial Go Live
February 2007 - Consumer Reference Group and Stakeholder Reference Group formed
Mar/April 2007 - Tender documents released to market
March 2007 - Communications plan developed
May 2007 - Tender responses due
May 2007 - Interim findings of the Care Planning and Communication Trial due
November 2007 - Care Planning and Communication Trial concludes
Late 2007 - State-wide implementation begins
-----------------------------------------------------------------------------------------
When considering the program – what does one see?
First, essentially out of the blue, HealthConnect SA caused a requirements specification for Care Planning (which has not been disclosed) to be drafted. On the basis of this specification it seems a trial of some commercial software has been commenced. The trial went live, it is claimed, in November 2006. It is quite clear the selection process was neither thorough nor open given the time it took, the apparent absence of a tender and the non-publication of full evaluation criteria.
What is claimed (on the project web site) is that the Ozdocsonline was selected by the following process:
“Consultations undertaken with key stakeholders identified that, in order for the care planning and communication system to be effective, it must:
- improve health outcomes
- be simple
- protect patient privacy
- provide patient access and control
- facilitate communication and collaboration between the health care team
- be accessible at the point of care.
Based on these criteria, and following an assessment of existing care planning systems, the Ozdocsonline system was selected for the trial. “
Hardly the level of detailed requirements needed to determine the appropriate system for a twelve month trial.
But – whoops! – it seems someone noticed that the trial now underway (despite its use of both state and federal funds) is hardly the type of non-standard, non-integrated system or approach NEHTA (or anyone else who had a clue) would choose to sponsor without solid evaluation as to alternatives.
So what happens?
In February 2007, presumably after a little 'jawboning' from NEHTA or DoHA, suddenly we see the actual formation of some management and consultative committees and the beginning of consumer and stakeholder consultation. Bit late since the trial has already been underway for four of its twelve months.
Presumably the Communications Strategy mentioned for March 2007 is to provide ‘spin control’ for the impending mess!
One also has to wonder how much pressure was exerted to spend committed funds with such haste concurrent with the establishment of such a large team (16 people in total in the group as of March 2007).
What happens next should be fascinating! A tender for a longer term solution is to be issued in March 2007 – but this is being done in the absence of any input from an interim evaluation of the first half of the trial – let alone a completed evaluation of the 12 month effort!
The responses to the tender specifications (whose requirements are presumably based on gut feeling of what might work rather than evidence of what is actually working) and the evaluation report of the tender are to be completed at the same time.
There is nothing like planning for success! This is an excellent example of the saying ‘If you fail to plan, you plan to fail. ’According to the timetable the tender will get evaluated, a solution will be selected, consultations will be held and State-wide implementation will begin by late in 2007!
Oh, and also – in November 2007 the trial closes down and all the data vanishes, unless the unsuitable incumbent as far as NEHTA's standards (and common sense) are concerned gets retained on a permanent basis or practitioners start paying to retain their own information.
Even more amazing is the following from the Project Site
“The South Australian Care Planning Project will also need to undertake work to:
- Ensure the care planning system conforms, where possible, with the National e-Health Transition Authority's (NeHTA) standards for care plans.
- Ensure that the Health Provider Registry, developed and maintained by SA Divisions of General Practice Inc (SADI), includes allied health providers.
- Ensure the care planning system has decision support capability.”
Firstly – It is important to note that, as far as I know, there are no such things as NEHTA Standards for Care Plans (they certainly do not exist anywhere in the NEHTA Standards Catalogue), if indeed there are any recognized Australian Standards in the domain at all sanctioned by Standards Australia or the like. Second NEHTA is developing a National Health Provider Identifier which presumably will obsolete the local SADI effort – so just what is being planned here? Thirdly the vagueness of “Ensure the care planning system has decision support capability” is both vague and meaningless – especially given that addition of any really useful decision support to any care planning system is a major and complex undertaking which does not seem to be contemplated in this one-liner and certainly not in the time-frames proposed above.
While not wishing to be unreasonably critical (I am really keen there be ongoing development in the e-health space a quickly as possible) , it just seems to me this whole project is the wrong way to be going and is very far from what should be funded to further develop e-health. There is a real risk, I believe, that a serious waste of money and effort is occurring. I will happily publish here on the blog any reasoned explanation from the proponents of all this that can show I have got it wrong and that this is a well managed, strategically sensible, standards aligned, coherently planned, transparent and properly executed pilot and project.
Am I the only one who can see how silly and bizarre all this is, how poorly thought through it is, how it is lacking in any reasonable process, and how its chances of and substantive long term success are miniscule at the best?
David.
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