Useful and Interesting Health IT Links from the Last Week – 29/04/2007

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

http://www.fiercehealthit.com/innovators/2007

Top Healthcare IT innovators

Hello, and welcome to the first edition of our Top Health IT Innovators list. We’re excited to be showcasing what are regarded as some of the most interesting—and disruptive—companies we know of in the healthcare IT industry, including some we can
more or less guarantee you’ve never heard of (yet).

Consumer Health IT?

Wondering why you see so many companies working on consumer-type problems on the list, rather than the back-end gear touched by CIOs and network admins? That’s because this may be the year when consumers have more contact with enterprise health IT than they ever have had before. Many of the intriguing technologies we’re highlighting are designed to guide consumers in their care electronically, using smart interactivity and content. Why? Because while doctors are already good at working with standard internal records, they currently don’t have a smooth way to interact with patients online, link the patients into their own decision-making process or collect patients’ self-reported impressions of how they’re doing. We’re not talking about a big boost in the use of PHRs, though that may indeed happen; we’re talking about a two-way flow of clinical and personal information that the industry has never seen before.

If some of the vendors below get their way, though, patients, clinicians and health organizations will have an online data-sharing dialogue, improving outcomes and saving time and money in the process. It’s an interesting shift in the business, and one, that we think is long overdue. We also think it’s going to hit big and take root quickly, so look for some major changes in patient-doctor interactivity this year.

…..

This is a fascinating collection of ideas for Health IT Innovation. Visiting the site provides access to 10 different start-up Health IT entities all of whom have interesting ideas that may make a difference either in how health care is delivered or managed. Well worth a browse.

Second we have:

http://www.kablenet.com/kd.nsf/Frontpage/F3416139CA164565802572C9005A59E3?OpenDocument

MPs warned about e-health records

27 April 2007

The government has been accused of ignoring concerns about the privacy of the NHS e-care record

Contributors to a hearing of Parliament's Health Select Committee on 26 April 2007 claimed the government is pressuring patients for their information to be included on the Care Record Service.

One claimed that the Department of Health has adopted an attitude of "suppressed hostility" towards patients who choose not to be included in the electronic care record system, NHS patient Andrew Hawker told MPs.

Andrew Hawker, an academic who has written about information systems and described himself as "an NHS patient", warned that the implementation of e-care records should be deferred until core IT systems are fully installed and it has been "thoroughly tested for privacy".

"I feel like a passenger on board a plane," Hawker said. "The plane has not had many test flights, and some of those have crashed. Meanwhile flight attendants are handing out brochures saying how safe it all is."

Further warnings were made by Paul Cundy, chair of the General Practitioners' Joint IT Committee. Cundy said that the summary care record, even in early adopter sites, shows signs of becoming far more than just a "summary" care record.

…..

This is another piece of evidence for three of the major contentions I have put in this blog. First that major technology initiatives have to be managed in a way they fully involves those at the coal-face. High level consultation during planning and implementation (with executives and managers) that does not reach the grass roots can pose a great risk to overall project success. Second developing an approach to managing privacy that clinicians and patient are happy with is vital. Third it seems increasingly likely that the best way to approach national e-health projects is to develop ‘bottom up’ implementation approaches and not ‘top down’ methodology.

On the same topic the following is also well worth a careful read – written by the developer of the 1998 Connecting for Health Program.

http://www.publications.parliament.uk/pa/cm200607/cmselect/cmhealth/422/422we54.htm

Evidence submitted by Mr Frank G Burns (EPR 60)

INTRODUCTION

It is, frankly, astonishing that a Committee of the House of Commons should, at the beginning of the 21st century feel compelled to undertake an inquiry into the value and mechanics of managing health care records in electronic form.
…..

The last important item regards SNOMED CT.

SNOMED sold to international organization

The College of American Pathologists has agreed to sell the intellectual property rights to its Systematized Nomenclature of Medicine Clinical Terms, or SNOMED CT, to the newly formed International Health Terminology Standards Development Organization, based in Denmark, for $7.8 million. CAP's decision to hand off SNOMED to an international organization was announced in January. To provide a smooth transition, CAP will continue to support standards-development operations with the new entity under an initial three-year contract and will continue to provide SNOMED-related products and services as a licensee of the terminology, according to an announcement today by the 16,000-member, Northfield, Ill.-based medical specialty society.

Charter members of the successor organization to the CAP and its SNOMED International division are organizations representing Australia, Canada, Denmark, Lithuania, the Netherlands, New Zealand, Sweden, the U.K. and the U.S.

"As the international adoption and use of SNOMED CT has grown, it has become apparent that an international governance structure that is open to the entire global healthcare community would be to everyone's benefit," said CAP President Thomas Sodeman, in a news release. "The college is proud to have assisted in this important milestone." -- by Joseph Conn / HITS staff writer

Details of what is happening in Australia can be found here:

http://www.nehta.gov.au/index.php?option=com_content&task=view&id=187&Itemid=144

A Canadian announcement of similar news can be found here:

http://www.infoway-inforoute.ca/en/News-Events/InTheNews_long.aspx?UID=267

The next step, for us in Australia, will be for NEHTA to announce the license conditions that will now operate and what the going forward arrangements for maintenance of the Australian version – including extensions for medicines etc.

http://www.healthdatamanagement.com/html/news/NewsStory.cfm?articleId=15057

Standard for ER Systems in Works

(April 25, 2007) A new “registered profile,” or a subset of an existing standard, could ease the creation of criteria to certify the functionality, interoperability and security/reliability of emergency department information systems.

Standards development organization Health Level Seven has adopted the Emergency Care Functional Profile as the first registered profile based on HL7’s EHR System Functional Model standard that was adopted in February. The functional model contains about 1,000 criteria covering more than 150 functions in such areas as medication history, problem lists, orders, clinical decision support, and privacy and security. The functional model is designed to provide guidance to electronic health records software developers and purchasers.

The new Emergency Care Functional Profile is a subset of the functional model, containing criteria specific to emergency department information systems.

…..

This profile is a useful step forward and will be of interest to all involved in emergency and ambulatory care system development. More information at the site.

All in all quite an interesting week.

David.

Something You Might Be Missing – The Comments.

As the blog has gradually acquired more readers there has gradually been an increase in the number of Comments posted after each article is published.

Neither the RSS Feed or the e-mail Alert lets readers know that new comments have been posted.

Since the beginning of 2007 there have been a range of really insightful and useful comments posted. (Thanks to all who have done so!) Can I suggest that readers occasionally scroll down the last few articles and check for new comments when visiting as I can find no obvious way to ensure these gems are not missed.

It is of note that many users often carefully consider their comments for two or three days before commenting so it is worth checking out at least the last week when visiting the site.

Oh! and before I go - yesterday it was a month since I have the note from DoHA regarding my letter to Mr Abbott. No response as yet.

David.

It Really is Very Hard to Make Shared EHRs Work.

Sobering news for all the proponents of Shared EHRs came in overnight.

The original article from E-Health Insider can be found at the following URL:

http://www.ehiprimarycare.com/news/item.cfm?ID=2635

iHealthBeat (http://www.ihealthbeat.org/) summarises the key findings well.

“Majority of British Physicians Oppose IT Project, Survey Finds

Sixty-six percent of British general practitioners said they will not allow their own health records to be shared through the National Health Service's Summary Care Record program, according to a survey of general practitioners by Pulse magazine, E-Health Insider reports. Only one-third of respondents said they plan to advise their patients on sharing their health information.
The survey also found that:

• About one-third of physicians said they will allow full sharing of their patient records;
• Four out of 10 physicians say they will opt out completely from the program and allow none of their records to be shared;
• 80% of physicians surveyed still think that sharing electronic health records can threaten patients' confidentiality, despite a government marketing campaign to promote the IT program; and
• 67% of general practitioners oppose the implied consent "opt out" model, which has formed the basis for the program to be rolled out, E-Health Insider reports.

Lord Warner, the former head of the NHS IT program, said that physicians have become "over-protective" of their existing health record system, according to E-Health Insider (E-Health Insider, 4/24).”

The lessons here are clear. The first lesson is that the implementation of a Shared EHR is a project which must be undertaken with continuing and ongoing consultations with clinicians and patients to ensure the directions being adopted are acceptable and will foster adoption and use.

The second lesson it seems to me is that in 2007 the Shared EHR is not a technical problem but a cultural change problem where is the trust of the users of the system is not developed and maintained the risk of failure of the overall project failure is greatly increased.

The third important lesson is that if the approach adopted minimises compulsion, maximises patient control of their information and maximises voluntary choice as to whether to use the technology or not, assuming good technical design, while slower to reach, genuine adoption and use is much more likely.

Separate from this report, the interested reader is referred to my article of March 15, 2007 which is found at the following URL:

http://aushealthit.blogspot.com/2007/03/shared-ehr-can-it-be-done-simply-and.html

Without going over old ground it seems to me a simple Shared EHR can be very useful, but only if it is developed in the context of using the information from advanced clinical systems to provide information to and retrieve information from the shared record. Clearly the shared record also needs to be properly standardised and securely transmitted, received and stored.

All this is easily done, using standard and well tried technology. Making use of the record voluntary for both doctor and patient is the way to go. With a voluntary record, I am sure what will happen is that those for who having their record available is important the service will be used, and those who are unsure or uninterested simply won’t. It should really be as simple as that.

I suspect that among those with chronic and complex disease, in the scenario I suggest above, there would soon emerge pressure on clinicians from their patient’s to upload records as “information insurance” for the chronically ill as well as assisting in the overall co-ordination and delivery of their care.

We must make sure any Australian initiative to develop and deploy a Shared EHR has these lessons from the UK firmly in mind and approaches the project in a genuinely voluntary way!

David.

It’s the Season for Silly Health IT Benefits Claims!

No sooner have we had NEHTA tell us how much we can save from e-Health but now we have a second entrant to tell us something different and even more incredible.

The Australian Centre for Health Research has just published (April 2007) a 19 page document entitled “E-Health and the Transformation of Healthcare”.

For those interested in reading the full document it can currently be found at the following URL:

http://www.achr.com.au/pdfs/ehealth%20and%20the%20transofrmation%20of%20healthcare.pdf


The headline claims from the executive summary are as follows:

“The impact on the individual can be imagined; the cost to the nation is immense. In Australia, it’s estimated that improved knowledge sharing and care plan management for patients with chronic disease would generate direct savings to the health care system of more than $1.5 billion per annum. Savings to the community from associated non-health care costs are of the same order. And increased workforce participation and productivity could add a further $4 billion per annum to the economy.

For the patients, home monitoring could reduce emergency room visits by up to 40%, hospital admissions by 30-60% and length of hospital stays by up to 60%.”

All I can say is “Here we go again!

”The argument made in the paper is:

• Disease Management (DM) and similar process improvement processes work
• Technology and ICT is an important enabler of DM
• If we approach Chronic Disease with technology there is a huge benefit possible.

This is all true as far as it goes. There is also no doubt – from a huge range of studies mentioned in other reports not cited here - that Health IT can make a difference. However the evidence as I read it does not support the proposed approach.

The paper does however get one point exactly right in the following:

“The Paper raises one final, important point - that of incentives. There is a cost to building this connectivity and information sharing but there is a mis-alignment between those who pay and those who receive the benefit.”

And rightly suggests who should pay

“Another important component is for the major beneficiaries of more efficient and effective health care (that is, governments, private insurers, and employers) to provide incentives for the use of electronic services, broadband health networks, and best practice processes.”

Of course we have yet to see any offers from Government etc to really ante up what is needed!

In summary the suggested approach is:

“ We should focus on three important areas:

1. get healthcare providers connected to one another
2. track health events across the continuum of care
3. create a broadband network of health services

In business, most high priority and high volume communications are handled electronically. But in health care, high-importance communications – e.g. referrals and hospital discharge summaries – are created using paper and pen and delivered via fax, letter and even by hand.

This is the point where we should begin – simply, aim to get referrals and discharge summaries to be delivered electronically in a convenient and secure form.”

To be polite this is a spectacular over-simplification of what is needed to achieve substantial benefit. Sure, - I have always been very keen on aiding the flow of key clinical documents electronically – but for a lot of good reasons this should be done in a secure, standardised, managed fashion and not as seems to be suggested here by provision of simple connectivity.

Likewise the second and third focus areas are dramatically more complex than identified in the paper.

The document has a ready, fire, aim feel to it. It is of note that the only Health IT benefits study that seems to be cited is this one while there are many other much deeper and much more recent studies readily available:

DMR Consulting, “HealthConnect Indicative Benefits Report”, Final Version, February, 2004 (extrapolated to latest chronic disease data). This can be found here:

http://www.health.gov.au/internet/hconnect/publishing.nsf/Content/C50C3B807441ADBACA257128007B7EC4/$File/hcibrv1.pdf

This document was so unpersuasive as to the available benefits of HealthConnect that the Commonwealth commissioned a review by the Boston Consulting Group (April 2004) and this review resulted in the change of HealthConnect from a funded strategic program to nothing more than a “change management strategy”.

Let me be clear about the problem I have with all this. Realistic estimation of the value of benefits from Health IT requires a clear exposition of what technology is to be implemented and how it will then provide benefit. To not have a Strategy for what is to be done, an Implementation Plan that describes how it will be done and a realistic Business Case that identifies both costs and benefits no one is going to care to take notice of, or action, unsupported claims of benefits.

We have seen two claims for major benefits that can be derived from Health IT (This present one and the study mentioned in NEHTA’s recent presentations). It seems passing strange that the two studies identify largely different sources of benefits and seem to come up with wildly different estimates of what is achievable.

The flaw in both studies is that they don’t proceed from a deep understanding of the business of Health Services Delivery and are not informed by what is needed at the clinical coal face. Only once the requirements and problems of the sector are clearly identified can a strategy to deploy technology to assist be developed and have a chance of success. Implicit in the strategy will be the benefit opportunities that will need to be firmed up. This is what then needs to be refined through the development of the implementation plan and business case which will reveal where investment makes sense and can make a difference. The last step (not the first) is to estimate the quantum of benefits and develop the approach to be used to capture them as implementation proceeds.

As I have said before the work required to convince the hard heads in Treasury to invest is substantial and needs to be a comprehensive package (Strategy, Implementation Plan, Business Case and Benefits Realisation Plan).

Without this work being done to a high quality I predict just nothing will happen.

These half baked studies do more harm than good I believe.

David.

Useful and Interesting Health IT Links from the Last Week

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

http://www.govhealthit.com/article98187-04-16-07-Print

Finding Foreman

George Foreman named his five sons George. Will the National Health Information Network be able to pinpoint his health records? Maybe. Maybe not.

BY Nancy Ferris

Published on April 16, 2007

George Foreman — boxer, clergyman and entrepreneur — named his five sons after himself. So when the Nationwide Health Information Network (NHIN) is up and running, how will a doctor find the records for the right George Foreman?

Accurately matching patients with their electronic records is at the heart of the proposed network. But what if doctors search NHIN and find no records for anyone named George Foreman? If few matches are found, users will soon pronounce the network a waste of time and money, and they’ll abandon it.

However, if too many George Foreman records are found, the network could seem equally useless. Just imagine the number of records created over the years for the boxer’s sons and others with the same name who are not related to the more famous Foremans.

In that case, a doctor might be unable to determine which of the many records relate to his or her patient. If the doctor guesses wrong, the patient could end up with treatment that’s ineffective or even harmful. What’s worse in the eyes of many people is that the doctor’s employees could see the records of someone else’s patients.

Alternatively, someone from the doctor’s office could call the patient and ask questions such as, Did you ever live on Maple Street? Did you seek treatment for a broken leg in Grand Rapids? What was your maiden name? But that approach is labor-intensive and hardly seems to fit with the notion of a 21st-century information network. It also isn’t likely to provide enough value in return for the billions of dollars it will cost to create the network.

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As always see the sites for the full article. This is a useful listing of the problems you can face without really robust unique identifier approaches and is an especially large problem for Shared EHRs which do not have such technology at their core.

http://www.e-health-insider.com/news/item.cfm?ID=2618

IT and e-health is 'every nurse's business'

17 Apr 2007

IT and e-health is every nurse’s business because it has to be integrated into practice, nursing leader, June Clark, said on the eve of a major discussion at the Royal College of Nursing’s annual congress this week.

The discussion on the theme “Computerised records – what can they offer?” will be available online at the College website. Professor Clark, a former president of the college and chair of the RCN Information in Nursing Forum, told E-Health Insider she hoped as many people as possible in the e-health community would get involved.

She hopes the session will raise awareness on several fronts: “The first is awareness among nurses that e-health and IT and the introduction of IT into the NHS is every nurses’ business because it has to be integrated into nursing practice,” she said.
“The other awareness that I want to get across to this audience and more generally that electronic patient records must have appropriate nursing content, not just medical content.”

…..

Another useful point is being made here – the reason we prefer the term “Health Informatics” rather than “Medical Informatics” - it the Health IT needs to be used by all health professionals if the full benefit is to be achieved.

http://news.zdnet.co.uk/itmanagement/0,1000000308,39286714,00.htm

Parliamentary report urges action on NPfIT

17 Apr 2007 09:26

Public Accounts Committee has published a report that calls for urgent action to reduce the risks of the NHS National Programme for IT.

The success of the NHS National Programme for IT is precarious, with key projects running late and suppliers struggling to deliver, according to a long-awaited report from Parliament's influential Public Accounts Committee.

"There is a question mark hanging over the National Programme for IT (NPfIT), the most far-reaching and expensive health information technology project in history," said committee chair Edward Leigh on 17 April.
…..

The full report can be found here:

http://www.publications.parliament.uk/pa/cm200607/cmselect/cmpubacc/390/390.pdf

There seems little doubt that the huge UK programme has a large number of both good and bad bits. Despite the differences in Health Systems there is always a lot to learn from such reports. Careful reading recommended for those involved in major Health IT projects.

Further perspective can be found in a recent editorial in the MJA entitles "Lessons from the NHS National Programme for IT" written by Professor Enrico Coiera of UNSW. See the following URL:

http://www.mja.com.au/public/issues/186_01_010107/coi11007_fm.html

http://www.smh.com.au/news/National/Report-backs-electronic-health-records/2007/04/19/1176696992965.html

Report backs electronic health records

April 19, 2007 - 5:39PM

Up to $7 billion could be saved each year if Australia's health providers shared patient data electronically, says a new report.

Commissioned by the Australian Centre for Health Research, the report argues a broadband network of health services should be created to allow patients to be tracked no matter where they go for medical services.

Monash University e-health research unit director Michael Georgeff said about one-quarter of all Australians suffered from a chronic illness and many had complex health needs.

"Chronic illness requires close monitoring and, often, intensive management by a team of health professionals," Professor Georgeff said.

"But because of the way our health system currently operates, one doctor will often not know what tests or medications have been prescribed by another doctor even when they are members of the same team."

…..

The full report can be found at the following URL:

http://www.achr.com.au

I have deep concerns about this report and it claims which will be the subject of a future article. Download it and consider the claims it makes for yourself. (It’s only 19 pages)

David.

Policy Relating to Comments on the Blog.

The purpose of this blog is to provide a forum for discussion of the issues surrounding Health IT in Australia.

In that purpose there is the desire, from me, for accuracy, honesty and openness from all contributors.

Lately there have been a number of anonymous / whistle-blower comments on specific topics.

My view is that I will publish these – as long as they are free of direct personal attack and other objectionable comment on the basis that sunlight is a very good thing in the public policy arena – which is where this blog engages.

I am also more than prepared to publish any contrary views – both anonymously and as named contributions. Such contributions are both welcome and encouraged. Objectivity and truth is what is sought here!

I am also not planning to censor discussion – but I will protect any party from gratuitous personal abuse where possible - , including deleting posts I am informed or see are defamatory, obscene or deeply personally offensive. I will, of course, be the arbiter of that.

I believe in an open and transparent society and that the organs of government that support society should be equally open and transparent.

Would it were so!

David.

ps - I know that this is obvious - but it needed to be said. D.

A Few Other Things Regarding the AFR Article on E- Health.

The Australian Financial Review Article of the 13^th April, 2007 entitled “National e-health would save $30bn” by Julian Bajkowski makes a few comments I really don’t think should go through to the keeper.

The article states:

“The study has increased pressure on the federal government to abandon a number of failing federal electronic initiatives, including the $128 million HealthConnect project, which has yet to deliver tangible results.”

I would suggest this is wishful thinking as we see the grossly overfunded non-strategic trials which are being still being conducted by HealthConnect SA and HealthConnect Tasmania. It would be good however if this was an outcome and they were canned.

The article states:

“ Doctors, clinicians and hospitals have long sought electronic health and medical records that could be used across Australia's different state health systems.”

This really misses the mark. Most care (95%+) is delivered within a patient’s local area and virtually all care is delivered in the state of a patient’s residence. Doctors would be very keen to see records for their patients able to be used between the local practice, the local hospital and the local investigatory providers. The rest would be a cherry on the icing on the cake I would contend.

The article states:

“But developing the standards has been a battle because of a series of bitter quarrels between technology suppliers and standards bodies.”

This is largely just wrong. Between NEHTA and Standards Australia’s (SA) Health IT working parties there have been tensions and a lack of quality two way communication – but the Health IT industry has, for the most part, very good relations with SA. Relations between the Health IT industry and NEHTA are dodgy, at best, despite anything NEHTA may say.

The article states:

“NeHTA recently recruited the former head of Queensland-based Cooperative Research Centre for the Distributed Systems Technology Centre, Mark Gibson, as its chief technology officer.

The hiring represents a coup as it will ease NeHTA's access to a vast repository of e-health-related intellectual property held in trust by the shareholders of DSTC after the group's funding was terminated by the federal government in 2005.”

While not commenting on this particular appointment directly, I seriously doubt there is much useful intellectual property held in trust by DSTC given the failed and never properly reported HealthConnect trials it was involved in.

I hope these comments assist in understanding where things currently sit.

David.

A Headline To Die For - National e-health would save $30bn – Pity it’s a Wild Unsupported Bit of Speculation.

Friday 13 April, 2007 will go down in history as a very black day for e-Health in Australia. On that day, based on an apparent back door leak, Julian Bajkowski of the Australian Financial Review published an article entitled “National e-health would save $30bn”. This assertion is based on work undertaken by the National E-Health Transition Authority (NEHTA) under its Benefits Realisation work program and is based on a Systems Dynamic Model developed by modelling consultants. Before discussing the details it is important to keep in mind a very important fact about all such models. That is that ‘no models are correct, but some are useful’ (Robert Box)

Regular readers of the blog will wonder why I should be concerned by this claim of such huge net benefits. The reason is very simple. While I firmly believe there are major benefits to be harvested from the deployment and use of e-health – and I believe the literature makes it reasonably clear where they are to be found – such claims are simply unsupportable without very substantial additional evidence.

NEHTA talks of the model they have developed in the following terms:

Modelling approach used for the study
• System Dynamics Model:
- Increasingly preferred (e.g. NHS)
- 900+ variables, 300+ calculation nodes, 25 sectors
• National and international expertise engaged:
- Jurisdiction, consumer and clinician input
• Focuses on major e-health benefits, costs and relationship to demand, quality and safety as e-health initiatives are rolled out over a 10 year period

Additionally they cite a range of published evidence from CITL, RAND etc and claim that from 3400 papers published since 1980 that Adverse Drug Events can be reduced by 50% (or more) by using Computerised Physician Order Entry (CPOE) with effective interactive decision support – among a range of other benefits that have been identified for e-Health.

They also suggest that there are 500,000 years of life to be saved in the Australian Population over 10 years with the implementation of e-Health.

What is conspicuously absent from all the presentations is the ‘how’? We are not told any of the basics that are required to make this credible. Obvious questions are:

What is the strategy, transition and implementation plan to move from where we are now to this 10 year future nirvana? If you don’t have that properly understood, documented and agreed with stakeholders how can you make any sensible comments about possible benefits? This is serious cart before the horse material I believe!

What are the assumptions for the capabilities of the systems to be used in hospitals and ambulatory practice to achieve these benefits? (It should be noted CPOE is notoriously difficult and complex to implement in hospitals – to the extent that – when last I looked – no more than 5% of hospitals globally have such systems in place. They are also not cheap to buy and implement.)

How much will such systems cost and who is going to pay for them?

What is a realistic time frame for replacement of present systems with the new more capable systems assuming they are readily available?

Given the vast majority of patient care is delivered in the private sector just what incentives (from Government) will be required to get the private sector on board?

Do we have the doctors, nurses and pharmacists who are sufficiently well trained and skilled in IT to make the transition to the e-health way of doing things?

Who is going to capably manage and co-ordinate such a huge change management and technology implementation program?

Are the assumptions in the model regarding a Shared EHR strategy correct? Is that ultimately the right approach for Australia? There is certainly a case for a careful review of the options being deployed around the world.

So what do we have here? Essentially what we have is a model without a strategy for architecture, implementation, funding and subsequent benefits management. There is no point putting out a generic claim about a possible scale of benefits without laser like clarity on just what is being proposed – or the economic hard heads in Treasury will shoot you down before you get started. This is where my concern lies. We have a once in a generation chance to propose a major re-investment in e-health for Australia and for it to succeed we need a model of an implementable and stakeholder approved strategy and implementation approach. Without clear and totally credible answers to all the questions I pose above, this initiative will turn out to be an expensive waste of time and effort.

It is vital in all this that those managing this proposed implementation ‘under promise’ and ‘over deliver’. I see no evidence of that approach in all this.

It is all very well for the Financial Review to publish an exciting headline and it is always important not to let the facts get in the way of a good story but I really think a little more digging regarding the reliability of NEHTA’s numbers, the assumptions and risks involved, the underlying strategic assumptions and recognition that things are usually much more complicated than they appear in a proposed, and largely yet to be defined, project of this scale would have been useful.

I look forward to NEHTA’s release of the Strategy and Implementation Plan that the model assesses along with the model and its assumptions. I will not be surprised to find I am once again disappointed and that sadly it all turns out to be largely ‘smoke and mirrors’ which will get us nowhere.

A final point that should be made is that the NEHTA Benefits Case relies on the deployment of clinical decision support (CDS). That, CDS, is sadly not actually part of NEHTA’s work plan as currently published. If it is actually worth so much, focus is needed and fast! Whoops!

We will wait and see!

David.