The Not-so-Special e-Health Budget Special

It is fair to say it has been a bad budget for e-Health in Australia at the Federal Level.

The National e-Health Implementation Expenditure has essentially been halved from the 2006/7 financial year to the 2007/8 year.

According to the Departmental Papers the plan is as follows:

Progressing the e-Health Agenda

In 2007-08, the Government, through the Department, will continue to work with all states and territories, health professional groups and consumers, to address those aspects of e-Health which require national leadership and coordination. The Government will continue to invest in key elements of e-Health infrastructure where a common, national approach is required. The Department will specifically oversee the development of national standards to ensure compatibility of e-Health systems across the health network.

Program 10.2: e-Health Implementation

The e-Health Implementation program funds a range of activities aimed at delivering e-Health infrastructure where a common, national approach is required. This is achieved through encouraging the development of national standards to ensure compatibility of e-Health systems across the health sector. The contribution to this outcome is measured by the uptake of e-Health initiatives.

Program 10.2: e-Health Implementation

Appropriation Bill 1

$,000

2006/7 2007/8

Budgeted 78,972 40,041

Actual 78,972 40,041

It is useful to compare this with what was said last year( 2006/7).

Leadership in eHealth

In 2006-07, the Department will focus on supporting the development of the electronic clinical communication’s architecture, individual health identifier and provider index, to enable a national electronic health record, which will contain a summary of important health information for use by both health care providers and consumers. The Department continues work in collaboration with all States and Territories on the e-Health strategy, and with the National E-Health Transition Authority on standards and infrastructure.

Program 10.2: e-Health Implementation

The Broadband for Health Program provides funding to health care providers for connection to high speed broadband. The program’s success is measured by the number of community pharmacies, general practices and Aboriginal Community Controlled Health Services who have connected to a broadband service that qualifies under the Broadband for Health Program.

Program 10.2: e-Health Implementation

Appropriation Bill 1

$,000

2005/6 2006/7

Budgeted 53,670 56,768

Actual 53,670 56,768

The most interesting changes from last year are:

1. We now have no mention of national e-health strategy

2. The concept of an national electronic health record has gone from the papers

3. The proposed funding has been essentially halved.

4. Broadband for Health seems also to have vanished.

For context the total Commonwealth Health spend is 42,964M, so the e-health spend is less than 0.001% of the total!

Note that neither HealthConnect or NEHTA are not mentioned as being funded in either sets of papers – so I have no idea where the NEHTA money as well as money being spent in Tasmania, SA and the NT actually comes from. Certainly it seems HealthConnect is dead!

The other implication of all this is that should the Australian Health Information Council come up with a useful e-health strategy it would be be the 2008/9 budget before it would get funded - barring a real miracle and Health Ministerial change of mind.

I think it is pretty clear the Commonwealth Government simply does not get it! If anyone can spot any other e-health investments in the papers please let me know

A sad day.

David.

Here We Go Again!

The following statement was issued by the National E-Health Transition Authority (NEHTA) last week.

“Conversation: STATEMENT on the NEHTA Review

Subject: STATEMENT on the NEHTA Review

For more information:

Gabrielle Lloyde

NEHTA

gabrielle.lloyde –at- nehta.gov.au

0408 170001

STATEMENT on the NEHTA Review

Friday, May 04, 2007

The Directors of the National E-Health Transition Authority (NEHTA) wish to advise that they are seeking to complete an independent review of NEHTA as required under NEHTA¹s constitution.

NEHTA Ltd was established in July 2005 and funded jointly by all federal, state and territory governments for a three-year period to accelerate e-health in Australia. NEHTA¹s constitution requires Directors to commission an independent review of NEHTA¹s future direction two years after the company¹s formation.

The review will address the effectiveness of NEHTA in meeting its objects, as set down in the constitution, including whether these objects remain valid and appropriate.

To this end NEHTA will be engaging, via open tender, a suitably qualified professional services firm to undertake the review. The selected firm will gather information on all aspects of NEHTA¹s operations, including information obtained from:

• NEHTA and its Directors;
• Jurisdictions;
• Key stakeholders; and
• Independent research.

In addition, the review will consider the future direction for e-health reform and appropriate vehicle(s) to deliver the future directions. The review is required to be finalised by October 2007.

The findings of the review will be provided to the Directors in the first instance. A General Meeting of Members of NEHTA LTD will be called within two months of the review being completed to consider the findings.

ENDS

About NEHTA

The National E-Health Transition Authority Limited is a not-for-profit company established by the Australian Commonwealth, State and Territory governments on July 5th, 2005. It aims to develop better ways of electronically collecting and securely exchanging health information, to:

* Improve the quality of healthcare services, allowing clinicians to more easily access accurate and complete information about their patients

* Streamline the care of people with long term illness, who need to be looked after by many different health professionals, by enabling seamless handovers of care through for example electronic referrals and discharge summaries.

* Improve clinical and administrative efficiency, by standardising certain types of healthcare information to be recorded in electronic systems; uniquely identifying patients, healthcare providers and medical products; and reforming the purchasing process for medical products.

while maintaining high standards of patient privacy and information security.

NEHTA¹s Board of Directors is composed of the heads of all nine government health departments. In effect, this means that the national health care system owns NEHTA and its decisions.

Gabrielle Lloyde

Communications Manager

nehta National E-Health Transition Authority

Tel 61 2 8298 2620

Mobile 040 817 0001

E-mail gabrielle.lloyde – at-nehta.gov.au

Web www.nehta.gov.au”

There are a few comments that need to be made about this release.

First let us consider what the NEHTA review is meant to ascertain.

Excerpt from Constitution:

“41. REVIEW

41.1 The Meeting of Directors will facilitate an independent review of the Company in the first Month of the third year from the time of this Constitution being adopted to assess whether it has met its objectives and should continue in operation.

41.2 The Members will assess the review procured under clause 41.1. The Directors must call a General Meeting within 2 months of the completion of the review and (whether in person, by representative or by proxy) the Members present and eligible to vote may pass a resolution to wind up the Company by a 75% majority or determine the basis on which the Company will proceed.”

So the press release somewhat diminishes the importance of this review. This is an existential review to decide of NEHTA has met its objectives – and if so, how the work is to be continued and if not what new approach and plan will be adopted.

So just what are the objectives of NEHTA constitutionally?

Excerpt from Constitution:

“3. OBJECTS

The objects of the Company are any or all of the following:

3.1 To provide the critical standards and provide and manage the development of infrastructure, software and systems required to support connectivity and interoperability of electronic health information systems across Australia;

3.2 To research, develop and implement national health information projects including (but not limited to):

3.2.1. clinical data standards and terminologies including the development of standards and common terminologies for health information for clinical service delivery, planning, policy making and research purposes and communication between health systems in Australia;

3.2.2 patient, provider and product / service standards and directories / indexes that contain information necessary to uniquely identify patients, providers, products and services and other relevant information across the whole of the health sector in Australia;

3.2.3 identification standards to define the data structure and specification for capture and storage of information required or (sic) the identification of patient, provider and products / services in Australia;

3.2.4 a product services directory which contains information for identification of products and services;

3.2.5 consent models governing collection and handling of electronic health information;

3.2.6 EHR standards;

3.2.7 technical integration standards to define the structure and rules by which information is exchanged between systems and users;

3.2.8 supply chain efficiencies, including exploring options such as common forms of procurement, standard contracts and common purchasing processes;

3.2.9 user authentication and access controls to ensure compliance with privacy laws and the consent models which have been developed;

3.2.10 EHR secure messaging and information transfer including identifying and managing the development of a national security model for messaging and information transfer between healthcare providers’ systems;

3.2.11 a knowledge centre, providing knowledge-sharing and expert advice to the public and private sectors on business case development and implementation requirements for health information systems so as to meet national standards and architectures;

3.2.12 to encourage health information industry reform and to facilitate opportunities in driving technological reform in health information technology, so enabling consistent interoperability and implementation of national health information technology priorities; and

3.3 Any additional object with 100% of Members determine should be included in this Constitution at a General Meeting.”

A careful review of this set of objectives leaves on with the sense that the drafters expected substantial progress to be evident when the review is undertaken – noting that NEHTA was actually commenced in July / August 2004 and had its CEO appointed in November / December 2004 – giving the period to be assessed a length of 30 months at least.

My assessment of where NEHTA is currently at is as follows:

1. Thus far I cannot see a single life saved or a single dollar saved as a result of NEHTA’s exertions. I can however see the expenditure of tens of millions of dollars.

2. NEHTA has done some research but essentially has failed to develop or implement anything tangible.

3. It seems clear the Federal Government recognises that the decision to hand e-Health to NEHTA to solve the problem has been, at least, a partial failure – given the recent resurrection of the Australian Health Information Council (AHIC) by the Commonwealth Health Department. The alternate explanation that AHIC has been resurrected because NEHTA’s work is almost done and the next steps need to be planned – i.e. the post finalisation of e-Health Standards phase has arrived in Australia– is so crazy as to be laughable!

4. NEHTA is essentially unknown to the Health Sector at large and is seen as essentially irrelevant by most of the Health IT industry as they have yet to provide any additional value to that already delivered via Standards Australia.

5. NEHTA Compliance is treated as a joke essentially, even by Member governments, – see the various initiatives funded out of HealthConnect for all the evidence you need.

6. NEHTA continues to deny its need for a strategic view to guide its actions and preserve coherence.

7. The imminence of the review has resulted in a flurry of releases of half done and half thought out draft work to try and demonstrate value – which is clearly lacking.

I leave it as an exercise for the reader to determine their view as to how well NEHTA has met its Constitutional objectives, and how closely what is now says it is doing matches with what it was meant to do.

Sadly, we all know what comes next.

The independent review will be undertaken as a ‘commercial-in-confidence’ engagement by a tame and friendly professional services firm in private, the NEHTA Board will receive the report they want, to avoid any possible criticism, and the report will disappear and never be made public. Some time, probably just before an October 2007 election, NEHTA will issue a one page press release to say it has been independently reviewed, needs to change one or two small elements of its plan but otherwise all is well. Note the Constitution does not seem to require regular further reviews – so that is that – and we have NEHTA forever!

See how close I get to what actually happens over the next six months.

At the very least the review needs to be commissioned by, funded by, and reported to the Commonwealth Department of Health and then made fully public. It also needs to ask for public commentary and submissions on a final draft. Having NEHTA commission the review itself, and then to have its officers manage the review, is a “putting the fox in charge of the henhouse situation” in spades! NEHTA Officers are clearly in a situation of major conflict of interest, after all, the review is meant to determine if NEHTA should continue to exist or not . To not fully separate the reviewers and the reviewed, as seems to be proposed, is just a farce!

David.

Useful and Interesting Health IT Links from the Last Week – 06/05/2007

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

The Informatics Review : May 1, 2007 : Vol.10 No.9

http://www.informatics-review.com/index.html

Ten Simple Rules for a Successful Collaboration

Given that collaboration is crucial, how do you go about picking the right collaborators, and how can you best make the collaboration work? Here are ten simple rules based on our experience that we hope will help. Above all, keep in mind that these rules are for both you and your collaborators. Always remember to treat your collaborators as you would want to be treated yourself—empathy is key.

Ten Simple Rules for Reviewers

There is no magic formula for what constitutes a good or a bad paper—the majority of papers fall in between—so what do you look for as a reviewer? We would suggest, above all else, you are looking for what the journal you are reviewing for prides itself on.

Ten Simple Rules for Getting Grants

At the present time, US funding is frequently below 10% for a given grant program. Today, more than ever, we need all the help we can get in writing successful grant proposals. We hope you find these rules useful in reaching your research career goals.

Ten Simple Rules for Making Good Oral Presentations

Clear and logical delivery of your ideas and scientific results is an important component of a successful scientific career. Presentations encourage broader dissemination of your work and highlight work that may not receive attention in written form.

Ten Simple Rules for Getting Published

When you are long gone, your scientific legacy is, in large part, the literature you left behind and the impact it represents. I hope these ten simple rules can help you leave behind something future generations of scientists will admire.

…..

This is a useful collection of tips for those in the academic community who need to develop and maintain an academic profile. Useful for all those hoping to establish them in Health IT Academia!

Second we have:

http://healthdatamanagement.com

EHR Pioneers Try to Stay Out Front

Latest projects include adding decision support, improving connectivity and developing PHRs.

By Howard J. Anderson, Executive Editor

Like the pioneers who headed West, blazing trails for millions of others to follow, a handful of hospitals and clinics in the final decades of the 20th century were electronic health records pioneers. They took the risk of automating clinical information at a time when many organizations were just taking the first steps toward automating financial records.

Many of these same trailblazers are leading the way toward a new generation of clinical automation decades after they began their original quests. And their efforts continue to yield many important lessons for others following in their paths.

…..

This is a useful set of suggestions as to where the second generation of EHR’s is heading. A long but worthwhile article. In the same May issue there is also quite a useful discussion on the unexpected security risks associated with embedded software in hospital equipment such as dispensing machines.

Third we have:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070502/FREE/70502003/1029/FREE

Paper records more secure: survey

By: Joseph Conn / HITS staff writer

Story posted: May 2, 2007 - 9:02 am EDT

A plurality of people in a recent survey indicated paper-based medical-records systems are more secure than electronic records, but under emergency circumstances, a large majority also indicated the rewards of having their medical records made electric outweigh the risks, according to a survey released today by Kaiser Permanente.

The Oakland, Calif.-based integrated delivery system sponsored the random, national telephone survey of 1,000 adult U.S. residents by StrategyOne, a unit of the Edelman public relations firm. Kaiser, which is undertaking an overbudget and overdue multibillion-dollar healthcare information technology rollout, is hosting a healthcare IT conference today in Washington.

According to the survey, when asked which form of record system was more efficient, 72% of respondents chose computer-based compared with 19% for paper-based, with 8% answering they were unsure. But when asked which type of medical records system was more secure, 47% chose paper, 42% computerized, and 10% were unsure. (Some numbers do not add up to 100% due to rounding.)

Survey participants also were asked whether they agree or disagree with the following statement: "The benefits of electronic medical records, such as better treatment in an emergency and a reduction in medical errors outweigh any potential risk to patient privacy or the security of patient information." Their answers: 21% indicated they strongly agree, 52% somewhat agree, 16% somewhat disagree, 9% strongly disagree and 2% indicated they didn’t know or were unsure.

…..

The complete article provides a range of interesting findings that slightly belie the headline. Indeed the relative safety of paper vs. electronic records was close to balanced and that many people clearly understood the benefits of electronic records. It seems likely that even a limited public educational program regarding the risks and benefits of EHRs is likely to be quite successful.

Fourth we have:

http://www.dallasnews.com/sharedcontent/dws/classifieds/news/jobcenter/news/stories/DN-informatics_29emp.ART.State.Edition1.4320696.html#

Nurses bridge gap between IT, care

Brave new paperless world opens opportunities for more nurse informaticists

08:59 AM CDT on Monday, April 30, 2007

By SUSAN KREIMER / Special Contributor to The Dallas Morning News
More and more nurses have been bridging the gap between information technology and clinical practice. And Mary Beth Mitchell, a registered nurse, finds herself happily positioned at these crossroads.

"It is not enough to have programmers and engineers designing and implementing these systems," said Ms. Mitchell, director of clinical informatics at Presbyterian Hospital of Dallas.

Nurse informaticists are needed as the advent of electronic health records ushers in a preference to go paperless. At least 75 percent of nurse informaticists are developing or implementing clinical information or documentation systems, according to an industry survey. A shortage of these experts bodes well for nurses considering this niche.

…..

An interesting article revealing the truth those of us who have been in the field for a while. “Don’t forget to involve and work with the nurses from the very start of any project”!

Enjoy!

David.

A Useful Contribution from the e-Health Initiative and Foundation

The following arrived in my e-mail today – and is really worth passing on as it provides some useful information and resources. Registration is free.

This material will really be of interest to all those with an interest in health information sharing.

----------

Dear eHI Members and Friends,

I am delighted to share with you, the eHealth Initiative Foundation's (eHI's) release this afternoon, of both research findings and a fully customizable set of new communications tools designed to enhance consumer understanding of the benefits of health IT and health information exchange (HIE). This work is in support of eHI's mission, which is to improve the quality, safety and efficiency of healthcare through information and information technology.

The public education and communications toolkit being launched today, entitled the InformationSTAT Program, was developed by eHI with support from the U.S. Department of Health and Human Services, which provided funds to strengthen Gulf Coast health care services and regional electronic health information infrastructure in the wake of Hurricanes Katrina and Rita.

The eHI web-based tools and resources include downloadable public announcements for radio, "print-ready" artwork for advertisements and billboards, case examples, and brochures on the importance of electronic health information exchange. The more than 30 resources made available today also include partnership development guides and customizable brochures and powerpoint presentations which local sponsors can use to reach out to practicing clinicians and employers to engage them in health information exchange efforts across the country. Access to the InformationSTAT program materials are available free of charge through the eHI Connecting Communities Toolkit. Sign-in is required.

These communication tools were informed by consumer research on health information exchange conducted by Public Opinion Strategies LLC also being released today. A summary of research findings is below:

• Support is extremely strong among consumers for secure electronic health information exchange with 70 percent of respondents favoring its development;
• Consumers recognize the benefits of secure electronic health information exchange and that the more they learn, the greater their support;
• Addressing policies for information sharing up-front and explaining those policies is a must have, particularly in the areas of security, patient permission, consent and access;
• Consumers overwhelmingly trust doctors the most to deliver them information about secure electronic health information exchange; and
• Almost half of consumers believe that their doctors already keep their medical records in electronic form, and a majority believe that it is likely that their doctors' medical records have a back-up copy off-site in electronic form.

These important tools are designed to support both national organizations and states and communities in the early planning stages as they reach out to the public in their regions, to raise awareness of why health information exchange is important, while highlighting safeguards that are in place to protect privacy and confidentiality of health information.

I am delighted to say that eHealth Initiative Vice President Ticia Gerber is spearheading this communications effort within our organization. Please feel free to reach out to her directly (via email at ticia.gerber@ehealthinitiative.org or by phone at 202.624.3264) or to me if you have any questions, would like more information on the eHI communications toolkit and related research, or would like to help eHI "get the word out" on the importance of health IT and health information exchange to as broad an audience as possible.

Sincerely Yours,

Janet M. Marchibroda
Chief Executive Officer
eHealth Initiative and Foundation
818 Connecticut Avenue, N.W., Suite 500
Washington, D.C. 20006
(202) 624-3270

----------

The material can be accessed at the following URL:

http://www.ehealthinitiative.org/news/CommToolkit.mspx

David.

Finally, An Communiqué from the Australian Health Information Council - Almost!

The Australian Health Information Council (AHIC) has finally released the communiqué you release when you don’t want to release a communiqué! To cover two meetings, of a still unknown number of members held over the last two and a half months, we get a single page notification that the meetings have been held.



What else do we learn?

1. The AHIC has a one year work program.

2. The Chairman is Professor James Angus, Dean of the Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne.

3. There are two executive committee members 1. Professor Enrico Coiera, Director of the Centre for Health Informatics, and Ms Yvonne Allinson, Executive Director of the Society of Hospital Pharmacists of Australia. The rest of the membership is not disclosed.

4. The role of AHIC is now that “The AHIC gives independent policy advice to Australian health ministers through the Australian Health Ministers’ Advisory Council (AHMAC). It provides the end users’ perspective on long-term directions and national strategic reform in health information management and information communication technology.”

5. A generalist Health, and non Health IT, consultant has been engaged to develop a yet to be finalised and possibly disclosed work plan for the next 12 months – after which time who knows what will happen.

6. There will be, at some future point, an e-Health Future Directions Summit, with members of the National Health Information Management Principal Committee being invited to attend.

7. The summit will examine the elements that will need to be in place in the next five to ten years to increase the provision of high-quality, timely information that will help consumers, clinicians and the health system to make the best decisions.

8. The new committee likes workshops rather than business meetings.

What have we not been told?

1. Just what the terms of reference of AHIC now are, who are the members and their affiliations, what were the criteria for selection and what proven track record do the members have in national health IT strategic planning.

2. Why AHIC just vanished and stopped meeting for approximately two years and has suddenly been resurrected.

3. What has happened to the AHIC web-site at www.ahic.org.au

4. Now we have resumed the a full work program – what were the outcomes of the old work program. (Does this remind anyone of the evaluation reports for the HealthConnect Trials?).

5. How end-users doing a future plan is going to influence the evolution of the supporting technology.

6. What is the relationship between AHIC and NEHTA? How are the work plans co-ordinated etc?

7. What are AHIC’s actual powers or is it just an advisory toothless tiger. The transmittal e-mail strongly suggests the latter.

“Subject: The Australian Health Information Council Communique - April 2007 [SEC=UNCLASSIFIED]

Dear eHealth Industry Member

Please find enclosed the April 2007 Australian Health Information Council Communique for your information.

The Australian Health Information Council (AHIC) is a multidisciplinary expert group that provides advice to the Australian Health Ministers via the Australian Health Ministers Advisory Council (AHMAC) on information management and communications technology development in the health sector from the end user perspective.

AHIC is an advisory rather than a decision making body and works in conjunction with industry, the public and private health sectors and professional bodies to formulate strategic advice.

The Council is chaired by Professor James Angus, Dean of the Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne, who also represents AHIC on the NHIMPC.

The AHIC has agreed that a Communique outlining their activities will be forwarded to eHealth industry members following each meeting.

The AHIC Secretariat is provided by the Department of Health and Ageing. Should you wish to contact the Secretariat please email ahic.secretariat – at- health.gov.au”

8. Other than one page communiqués are there going to be any substantive documents and reports produced by AHIC.

9. Is AHIC going to at any time publish minutes of meetings etc so those interested can be informed as to the directions considerations are taking.

10. What is to happen after the one year resurrection is over in April 2008.

11. What accountability will the AHIC members have for the outcomes in the e-Health domain.

12. What budget has been allocated to support the AHIC Strategic Planning Process?

The important point I see is that AHIC's role seems to be fundamentally different from the past. Rather than being concerned with e-health strategy and its implementation it is now an end user committee based on the assumption that it will all magically come technically together under NEHTA's skilful strategic guidance.

This is really nonsense - we need to get the user needs and the technology aligned and managed as part of a coherent forward plan. I don’t see AHIC being tasked or enabled to really undertake this. The complexity and subtlety of the plan that is required would severely test the Booze Allen’s and McKinsey’s of this world - The clinician engagement strategy of itself will need to be a masterpiece!

Some colleagues are suggesting I wait and see what happens over the next few months. From what I have seen so far I do not hold out much hope for real improvement unless the complexity of developing such a plan is fully recognised and addressed – and time allowed to consult very widely and get to some sensible answers.

I see it as vital there is a push pushing for openness and for doing this plan properly - rather than the planned approach of develop a briefing paper and having one day a meeting with 30 people around the table try to solve some really hard problems on a limited (very limited) information base of where everyone is up to (govt private sector, vendors etc), where the big gaps are and having no clear developed view of what is possible and doable and what the strategic choices really are.

I really feel that unless a really expert in-depth piece of work is done it won't go anywhere and another opportunity will be wasted.

Australia has done the lacking real depth type of planning exercise that is proposed couple of times in the last decade, and we find ourselves where we are.

I also don't think this can be done in chunks or parts - I really believe a proper job needs to be done - looking at current state of e-Health, e-Health governance, technology futures, clinician engagement approaches, costs, benefits, risk management, sector participation and so on.

Surely the lesson of the last decade is that if you do it by half you wind up with very little!

I believe it is time to give it one really good shot and get it right!.

David.

Are You Tired of Being Treated Like a Mushroom – Kept in the Dark and Fed Manure?

This posting will be short and to the point. I was wondering, over the weekend, how many others in the e-Health community feel that all the confidentiality and secrecy surrounding e-Health planning and progress has got a little out of hand. I suspect it may be part of the present electoral cycle but recently I have been seeing two main things happening.

First we have seen all sorts of documents from NEHTA which even by their own admission were just a preview rather than something that could actually be implemented for testing etc. Among the documents I put into this category are:

1. The various technical documents incorporated in the e-Procurement Hub Tender released a month or two ago.

2. The so-called Release 1.0 of the Australian Medicines Terminology (AMT) which was much more like a Release 0.01

3. The Pathology Terminology Reference List v1.0 - Release Note and associated documents

4. The still unreleased document explaining the Selection of HL7 for Australia and what the reasons for the decision were and what the implications for the e-Health Community are. (This document also is one of the secret ones that has been reviewed by consultants – but not been made public for comment by others who might be interested.)

The big question here is why all the haste and why release work that is half finished. Another secret I suppose but I can guess. Maybe a performance review is due?

Second we have news that the Department of Health and Aging (DoHA) and the Australian Health Information Council (AHIC) are working to develop a new e-Health Agenda for the country through a process that is distinctly reminiscent of the work undertaken by the Boston Consulting Group in 2004 and which has led to the present rather unsatisfactory situation in e-Health overall.

Last week a colleague mentioned, in passing, that this directional study was being commissioned and that it was intended that the outcome would be available for consideration by July / August 2007.

Having considered the prospect of such a strategic study, I responded as follows, outlining three points I found concerning about an apparently time, depth and transparency limited approach to the planning.

“First an assumption I have always had regarding any new national strategy is that we should work hard so we don't repeat the mistakes of previous work. These mistakes have certainly included a lack of inclusiveness and a lack of proper consultation with the actual health system and health system providers rather than bureaucrats, peak body representatives and medical politicians as to needs priorities and problems to be addressed. I am not sure what is now asked for is very much the same or not but I think it needs to be raised as a possible risk.

Second, even with a very clever approach, there is a risk of having “lots of time to do it again but not enough time to do it properly”. I also see that as a risk as this is very much a 'last shot in the locker' for 5 years at least. I also fear the political cycle may put time pressures on the project that may make the outcomes less than useful.

My last comment is that, with the way this is all unfolding, the standard operations procedures of DoHA and NEHTA, with almost paranoid confidentiality etc will dominate. This is a worry as it will be a block to getting a real diversity of view and choices to consider. Being 'inside the beltway' can give a very false view of the world.”

I hope my colleague can feed back some of these concerns to the powers that be!

I have no idea how all this will work out ultimately. Given that AHIC has already met twice and there is no public outcome one cannot be all that optimistic. When checked today the AHIC URL was still inactive and I discovered we have a new peak Health Information Management Committee – called the National Health Information Management Principle Committee . There are only two references on the web to this committee and its membership seems pretty obscure. Their functions etc can be found at the following non-DoHA site. More secrecy and very odd I must say!

http://www.e-health.standards.org.au/cat.asp?catid=11

It is amusing that the page lists all the key standing committees but does not mention AHIC!

I really despair of all this – but must continue to hope I guess.

David.

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.

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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.
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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.

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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.