The Mess in the West.

About a year ago (22^nd June 2006) an entity of the Western Australian (WA) Health Department styled Healthtec conducted a briefing on the forward plans for Health Information Technology in WA.

The briefing was told that this Technology division was established on 1 January 2006 with the role of managing WA Health’s information, communication and medical technology. In doing so, Healthtec intended to lead a significant enhancement of current systems and infrastructure under the Health Reform and Implementation Taskforce HRIT ICT Program (HRIT ICT). This included the replacement program for patient administration and clinical health information systems (HIS).

In the WA Health Operational Plan 06-07.doc – Revision 25 - 28 Apr. 06 there is a section entitled “Ensuring our information and communication technology(ICT) aligns with the Clinical Services Plan“ (section 5.5)

The timeline proposed was as follows:

1. ICT and medical technology master plan completed by July 06

2. Expenditure Review Committee approval of ICT program business case by December 06

3. Release of ICT RFT/Tender by January 07

4. Establish contract form supply of ICT systems by June 07

5. ICT Implementation strategy and timetable endorsed by SHEF by May 07

6. Commenced implementation of ICT infrastructure plan deployment by June 07

A little further research reveals this was already a modified time line.

From the WA Health Clinical Services Framework - 2005 – 2015 dated 21/09/2005 we read:

“3.4 Information and Communication Technology Framework

Supporting the CSF and a number of health reform projects is an Information and Communication Technology (ICT) strategy.

The ICT program will deliver a system-wide integrated clinical information system that will incorporate the public and private hospitals, community health, primary care and mental health sectors. This new system will be progressively implemented across the state and will include electronic patient records, single patient identifiers and provider identification.

The ICT program will engage stakeholders in the development of system requirements for all clinical modules. This process is now almost complete. After further discussions with stakeholders and the completion of the regulatory processes, the Department of Health will proceed to a tender process in the later part of this year” (2005).

Worse we can also note that the Reid Review (March 2004) “A healthy future for Western Australians, Report of the Health Reform Committee, WA Health Department, Perth” said in Recommendation 18:

“The Department of Health should progressively implement a system wide clinical information system which incorporates the public and private hospital, community health, primary care and mental health sectors. The system would include electronic patient records, unique medical record numbers and provider identification.”

So, after all the fanfare of the major Health Department Review of 2004 and the other plans mentioned above we find a central element – ICT Implementation - slipping comprehensively and disastrously. I am sure all this would not have been helped by the reported loss of the Executive Director of the Health Technology Area due to some administrative issues. (Not that this departure seems to have resulted in any update of the Health Department Web Site)

See http://www.health.wa.gov.au/tech/home/ (as of 19 June, 2007 where the page seems to be the same as that I saw in June 2006, one year previously).

As far as I am aware we are still to see any completed significant Health IT procurement action. A review of the tenders sought and let by WA Health in the Government Electronic Market (GEM) didn’t locate any likely EOIs or RFTs.

This suggests a total slippage in the Health IT area that is now moving towards 18 months at best and three years at worst. Given the importance of progress in this area this really is amazing level of delay and inaction!

A possible reason for this apparent lack of progress may be found in the following report. The report is entitled “A Report Card on the WA State Health Service” and is written by Gavin Mooney who is Professor of Health Economics, Curtin University of Technology. (It is published as the Social and Public Health Economics Research Group (SPHERe) Debating Paper 1, 2007 – Dated May 2007).

The full report can be found at the following URL:

www.sphere.curtin.edu.au/debates/SPHERe%20Debating%20Papers%201%202007.pdf

The first thing to be appreciated is that Professor Mooney has been at this a while.

“He is recognised as a leading expert worldwide on efficiency and equity in health care delivery. He has over 30 years experience in advising governments in health care planning, including in the UK, Canada, New Zealand, South Africa, Spain, Denmark, Norway, Sweden and Iceland. He has acted frequently as an adviser to the World Health Organisation, and to the OECD.

He has authored or edited over 20 books and has more than 200 articles on health planning and economics.”

The second thing to be realised that he is convinced WA Health Department Management is in a state of virtual collapse:

The Executive Summary of the Report makes that clear!

"How is the WA health service now travelling? We have many dedicated, hard working, highly skilled health care workers doing the very best they can for their patients. Yet despite their efforts the people of WA are not getting the health care they deserve.

In the wake of the Reid Review of March 2004, this report reviews some key aspects of the WA health service and argues that most of the problems of the sector are not related to under funding as is often claimed. The causes of the problems lie much more in a lack of concern for efficiency; poor management at a senior level; an obsession with resourcing the tertiary hospital sector and with hospital waiting lists and emergency departments; an all too ready emphasis on keeping the health service off the front page of The West Australian and state TV and radio news bulletins rather than on what the informed public want from their health service; too little concern among policy makers with equity; an absence of any rational priority setting system; a neglect, amounting to negligence, of Aboriginal health; a failure to promote transparency and accountability in resource use; and a too great willingness on the part of health politicians and bureaucrats to listen to the special pleading of the AMA.

Fundamentally, the costs of the WA health service are out of control. The target for expenditure growth, according to the performance indicators of Neale Fong, the Director General of Health, is 5.5 per cent. It is difficult to obtain figures to show what the current growth is but it is more like 9-10 per cent. That is not sustainable even with the current minerals-led boom in the state.

Yet more worrying is that when the Fiona Stanley Hospital opens around 2012, given the lack of budget integrity surrounding the forecast running costs of that hospital, the annual rate of expenditure growth will rise yet further or we will see services being cut elsewhere, especially to disadvantaged groups - in the community, in rural and remote WA and for Aboriginal people. And the minerals boom may well be over by then.

A related but separate issue is that it is so difficult to get any sort of debate mounted on the state of wellness of the health service. Those of us, including this author, who try are criticised for airing our views.”

The summary then goes on to say that the WA Department of Health needs a wholesale overhaul in its management of people, resources, skills and priorities among other things.

It seems clear that the lack of progress in the Health IT area is likely to also be a symptom of the management malaise identified by Professor Mooney. Without improved information systems (which are mentioned in the full report) there is no doubt the difficulties being experienced will continue.

One can only hope both the managerial and technology issues will be addressed soon for the good of all Western Australians. This performance seen here really does suggest that, despite the mining boom, WA is coming a bad last! Its over three years since the Reid Report and as best one can tell zilch has actually happened!

I would love to hear from Western Australian readers who can tell me I have this totally wrong and that all is well!

David.

Is this the Last Chance for AHIC and e-Health in Australia?

A few weeks ago we learned that the Australian Health Information Council (AHIC) will be holding a summit on June 18 (evening) and 19, involving AHIC and the National Health Information Management Principle Committee (NHIMPC) (See Terms of Reference as an Appendix).

We also learned that in its role of providing advice to inform national policy direction for health information to the Australian Health Minister’s Advisory Committee (AHMAC), AHIC wished to look strategically at the development of the national health information program out to 2013.

To ensure wide coverage by the summit, the consultants that were engaged to conduct a survey, were asked to develop a systematic analysis of:

• what’s worked and what hasn’t up until now
• where Summit participants and your constituencies (if relevant) stand on the health policy imperatives moving forward
• what should be in place by 2013 (or before) in terms of e-Health infrastructure and specific IT and communications tools to serve those health policy goals, and
• what might be the right model(s) moving forward.

We were also told the survey would be collated and presented in advance of the summit.

For there to be any real outcome from the summit over the next few weeks those interested in the e-health agenda will need to see the following:

1. The prompt publication of the detailed outcomes of the survey. The survey report should be open for public comment for at least six weeks and a second report, including relevant public input, should be provided to AHIC and the NHIMPC is due course.

2. The prompt publication of a detailed set of minutes of the strategic considerations explored by the summit and their views on the findings of the survey.

3. The announcement of a strategic planning process roadmap to develop, over time, a coherent and implementable strategic framework for e-health in Australia.

4. The announcement of a public consultation plan, to include all relevant stakeholders, to assist in framing the strategic options and choices available to Australia.

What is vitally important in all this is a recognition that a national e-Health Strategy and Framework cannot be developed in a month or two. The summit needs to determine how a genuine strategic outcome can be achieved and not in any way leap to any views without in-depth stakeholder consultation and option analysis.

If the AHIC planning process does not move beyond the presently closed and secretive approach that is presently being adopted with selective consultation and ‘say as little as possible’ AHIC Communiqués I for one will be confident of a deeply unsatisfactory outcome for this planning initiative.

The members of AHIC and the NHIMPC should have no doubt of the importance of the present summit and ensure the outcome of the meeting is a genuinely open and consultative strategy development process. While it may seem to be drawing a long bow, many lives will be lost un-necessarily unless e-Health in Australia is got firmly back on the rails. All in attendance should ensure this thought focuses their attention and effort.

The summit attendees can find an example of the way consultative processes should be run by reviewing the approach adopted by the American Health Information Community (AHIC) which is the same type of policy body for the United States as our AHIC is for Australia. See the following URL:

http://www.dhhs.gov/healthit/community/background/

I firmly believe this summit amounts to the last chance to see real progress in e-Health in this decade. I hope the attendees agree and work hard for a set of quality outcomes and ways forward.

If the next few weeks pass without something like I suggest coming to pass it will be the final proof, if any was needed, of the continuing inadequacy or ineptitude of all those influentially involved in the e-health policy formation and will put the seal on a wasted decade. Those whose lives and businesses are damaged by the continuing policy failures will have every reason to be very grumpy.

In summary, if the summit does not result in the initiation of a public, inclusive, consultative and expertly facilitated and developed National E-Health Strategy, Business Case and Implementation Plan that suits Australia’s unique health system, health financing, culture and geography it will clearly be a dismal failure in the eyes of most who know anything about the domain. This is the last roll of the dice!

The sooner some very intense sunlight shines on this very dank policy corner the better!

David.
-----
Appendix for Information
Terms of Reference of NHIMPC

The role of NHIMPC is to advise AHMAC on planning and management requirements and to manage and allocate resources to health information projects and working groups.

NHIMPC will:
• advise AHMAC on national priorities in IM&T;
• align the allocation of national resources with these national priorities and outcomes;
• accelerate development and adoption of information architectures and data standards;
• promote alignment of jurisdictional strategic plans and activities with agreed national priorities; and
• oversee national activities.

NHIMPC is a committee of government nominees that reflects the interests of governments which primarily funds, regulates and manages health information.

Comment: The apparent overlap between this Committee and AHIC would seem to be rather problematic. That might be a useful first step – to sort out which committee is responsible for exactly what?

D.

AusHealthIT reaches 200 Posts!

Well, to my amazement we have reached 200 posts on the blog. I thought that might make a good moment to report back to readers what is being read, how often etc.

As of 3pm 17/06/2007 the site statistics (since site metering was initiated in September, 2006) are as follows:

VISITS

Total 14,549

Average Per Day 99

Average Visit Length 2:36

This Week 692

PAGE VIEWS

Total 23,952

Average Per Day 165

Average Per Visit 1.7

This Week 1,156

The 30 day moving average of page views is showing a healthy upward trend – allowing for the weekend drops – so I am encouraged to continue typing!

The major sources of visits are as follow:

Australia 66%

United States 12.3%

Unknown 5.0%

United Kingdom 3.5%

Canada 3.2 %

Rest of the World 10 %

The most popular items served by the RSS feed are as follows:

An Invaluable Reference on Health IT Value

1. Useful and Interesting Health IT Links from Last Week – April 2007

2. Personal Health Information Privacy – The Elephant in the Room.

3. Archetypically Stupid!

4. Electronic Prescribing – What is Needed to Move Forward ?

5. SA HealthConnect – What are they Thinking?

6. NEHTA’s Annual Report – What We are Not being Told?

7. Privacy Issues Related to the Proposed Access Card.

8. E-Mail Security and Clinical Practice – What’s Sensible?

9. SA HealthConnect Opens an Appalling e-Health Tender.

10. Clinical Research Information Now More Available.

11. E-Prescribing in Australia – Is there a New Plan

12. How Did iSoft Get into So Much Trouble?

13. AusHealthIT's First Guest Blogger Article.

14. Correction to Comments on South Australian OACIS System Security

15. NEHTA – How Far Has it Come?

16. Moving on Without NEHTA – Some Really Good News!

17. Even the Irish Recognise the Need for Better Health IT!

18. And Now for Some Really Good News!

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

20. Oh HealthConnect! – You Have Done it Again!

The article that has had the most impact to date with 195 visits and almost 400 page views was the short comment posted a week or two back entitled “There is Hope!”. I must admit to being surprised by that.

What I take from all this is that there is considerable interest in the news and associated commentary from the blog and that there is considerable interest in keeping an eye on some of the more dubious initiatives in the e-Health space.

Comments as always welcome – as are suggestions and tips regarding other topics that may be explored.

Thanks for reading!

David.

Useful and Interesting Health IT Links from the Last Week – 17/06/2007

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

These include first:

http://australianit.news.com.au/story/0,24897,21903727-16123,00.html

SA funds $375m health IT plan

Ben Woodhead | June 14, 2007

THE South Australian Department of Health is set to launch a $375 million information technology overhaul aimed at digitising healthcare across the state.

The 10-year initiative, which includes 65 individual projects, comes in the wake of intense lobbying from Department of Health IT executives for a systematic approach to upgrading patient information systems.

The $375 million program, which was funded in last week's South Australian state budget, is also designed to dovetail into national electronic health record initiatives.

The budget highlighted an $11.5 million capital injection for patient and nursing administration systems, but the overall 10-year project will allow the Department of Health to upgrade myriad other IT platforms.

…..( see the URL above for full article)

An additional article on this topic is found here:

http://australianit.news.com.au/story/0,24897,21870527-15319,00.html

SA kick-starts e-health

Ben Woodhead | June 08, 2007

SOUTH Australia's Department of Health has been given $11.5 million to kick start a long-awaited upgrade of its patient management systems that is eventually expected to cost as much as $70 million.

Patient system funding comes after extensive lobbying by SA's Department of Health

The funding was awarded in yesterday's 2007-2008 South Australian state budget and comes after extensive lobbying by the department over the past few years.

According to a South Australian Treasury capital statement issued as part of the budget, the $11.5 million will be used to support the replacement of several IT systems, including the ageing patient administration platform.

A nursing administration system overhaul will also be at least partially funded out of the allocation.

The patient administration system (PAS) upgrade is expected to take between six to eight years to complete because it will run in parallel with a number of other computer projects such as finance and material management software updates.

…..( see the URL above for full article)

These two articles are interesting for the claim of the very large investment ($375M) over a decade and then the detail suggesting the spend will be $11.5M in 2007/8. Suggesting it will take six to eight years to renew the patient administration systems (PAS) suggests to me this whole program has an air of considerable uncertainty and un-reality about it. If it takes longer than 1-2 years to renew a PAS environment something is badly wrong.

In passing, I note blog readers have yet to hear, after almost a year, about the individual patient privacy controls and protections offered by OACIS. I would look forward to any comments those in SA might have on these plans and the privacy controls within OACIS.

Second we have:

http://www.chcf.org/topics/chronicdisease/index.cfm?itemID=133288

Privacy, Security, and the Regional Health Information Organization

Avalere Health LLC

June 2007

Regional health information organizations (RHIOs), which promote electronic exchange of patient information among participants, are grappling with a variety of privacy and security issues as they evolve. This study, based on a literature review, interviews, and an informal survey, examines some of the key issues that nine RHIOs encountered and their strategies for managing them.

The study found that privacy and security challenges are surmountable. A RHIO’s unique characteristics—the types of data shared, who participates, and its specific needs and priorities, among others—influence how an exchange addresses these challenges. Solutions are diverse and evolving.

…..( see the URL above for full article)

The report can be downloaded at the following URL

http://www.chcf.org/documents/chronicdisease/RHIOPrivacySecurity.pdf

The most interesting point that emerges from this very valuable report is the observation the nascent Regional Health Information Organisations (RHIOs) may not be doing enough in the way of consultation to understand the privacy and security concerns of their stakeholders.

The report also found that the newer RHIOs could benefit significantly from sharing examples of effective privacy and security policies and past lessons. The report recommended flexible security policies that allow for future data and participation increases over time.

There are lessons here for those planning similar initiatives in Australia.

Third we have:

http://www.nytimes.com/2007/06/11/business/businessspecial3/11save.html?_r=2&ref=businessspecial3&oref=slogin&oref=slogin

Who Pays for Efficiency?

By STEVE LOHR

SAVING money can be expensive.

Indeed, the quest to save dollars in the nation’s $2.1 trillion annual health care bill is becoming a lucrative market of its own. Thousands of companies, large and small, are pitching cost-saving ideas that range from electronic patient records to new medical devices.

It’s not all marketing hype. Experts in health policy agree that there is a real opportunity to curb health spending, which last year was the equivalent of $7,000 for every man, woman and child in the country. Studies predict a gain of as much as 30 percent in efficiency, mostly through reducing unnecessary tests and prescriptions, paperwork and medical mistakes.

Such streamlining would not cut the nation’s total medical spending, as long as there is a growing aging population with ever-increasing health needs. But certain measures are expected to help keep costs from spiraling.

…..( see the URL above for full article)

Of most importance from my perspective was the following paragraph:

“Physicians get only about 11 percent of the savings from electronic health records; the real benefit goes mainly to private and public insurers because, for one, they are paying for fewer unnecessary tests, and automated record-handling is a big cost saving for the payers, according to a study by the Center for Technology Leadership, a medical research group. “The doctors bear all the costs, and others reap most of the benefit,” said Dr. David J. Brailer, who was the national health information technology coordinator in the Bush administration from 2004 to 2006. “The incentives are totally awry.”

While Australian data to support this assertion does not exist (of if it does I would love to know about it!) it feels close to true. Working out how best to handle this reality will be an important task for all those developing health information strategies globally – noting that all those I have just reviewed recognise the importance of the issue.

Fourth we have:

http://www.govhealthit.com/article98189-04-16-07-Print&ghitnewsletter=yes

Banking on privacy

States and the federal government take contrasting approaches to building large medical record repositories

By Alan Joch
Published April 16, 2007

As the federal government continues to push for wider adoption of electronic medical records, many organizations are asking how they can efficiently distribute and safeguard all of that electronic medical information once it’s captured.

One strategy is to create banks of records from which authorized doctors and nurses can quickly pull patients’ lab tests and medical histories. Proponents contend that care will improve and medication mistakes will decline when specialists and emergency room physicians have immediate access to the same information that a patient’s primary care physician has.

“There are tangible benefits we could see right away in quality, efficiency and cost savings,” said Dr. David Gifford, director of the Rhode Island Department of Health. “There aren’t many things that both help improve quality and lower costs, so it’s a real win-win situation.”

Although EMR banks are potentially beneficial, some privacy advocates have raised concerns. Public-sector medical groups, private hospitals and payer organizations, are trying to tackle such nagging details.

…..( see the URL above for full article)

This is a useful and quite long article that explores the privacy and security imperatives in the health sector and explores parallels and cross over with the banking sector.

Lastly the iSoft / CSC / IBA Health saga continues:

http://www.e-health-insider.com/news/item.cfm?ID=2780

Granger says IBA will take control of iSoft within week

14 Jun 2007

Richard Granger, chief executive of Connecting for Health, has exclusively told E-Health Insider that IBA Health will have control of iSoft within the next week.

However, Granger also warned that he was prepared to ditch iSoft's Lorenzo software, and make arch rival Cerner's Millennium the national system across England, if the late-running software doesn't work or meet NHS requirements.

Speaking to EHI after giving evidence to the Commons Health Select Committee Granger said that he had been in consultation with iSoft’s executive chairman, John Weston, and was confident a deal would be finalised by next week.

…..( see the URL above for full article)

From this report it would certainly seem there is a lot of behind the scenes activity going on. It might have been a good idea for IBA health to report Richard Granger’s intervention to the Australian market – which at the time of writing they have not (June 17, 2007).

Late breaking news – we now find:

http://www.computerworlduk.com/management/government-law/public-sector/news/index.cfm?newsid=3529

NHS IT chief Granger quits

Head of £12.4bn programme will go before roll-out of crucial care record system

By Tash Shifrin

16 June, 2007

Other useful finds this week include:

On privacy and access control we also have:

http://www.courant.com/news/local/statewire/hc-11012731.apds.m0269.bc-ct--e-hejun11,0,4560849.story

Privacy arguments follow rollout of electronic health records

Associated Press

June 11 2007

And,

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070611/FREE/70611004/1029/FREE

Data access control often just a mouse click away

By: Andis Robeznieks / HITS staff writer

Story posted: June 11, 2007 - 9:54 am EDT

http://masseynews.massey.ac.nz/2007/Press_Releases/06-12-07.html

Who should see our health records?

A new research project will investigate public attitudes towards the sharing of confidential personal health information held in electronic health records.

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070613/FREE/70613005/1029/FREE

Kolodner unveils AHIC's privacy policy framework

By: Joseph Conn / HITS staff writer

Story posted: June 13, 2007 - 12:18 pm EDT

http://www.upi.com/Health_Business/Analysis/2007/06/13/analysis_health_its_privacy_factor/8878/

Analysis: Health IT's privacy factor

By ROSALIE WESTENSKOW
UPI Correspondent
WASHINGTON, June 13 (UPI)

All in all quite a bumper week for issues around privacy!

More next week.

David.

A Curious Interview with NEHTA.

An interview with NEHTA’s CEO appeared in the Australian IT section last week. It can be accessed at the following URL:

http://australianit.news.com.au/story/0,24897,21848256-15319,00.html

E-health standards advance

Karen Dearne | June 05, 2007

THE National E-Health Transition Authority is pursuing software industry engagement through a growing relationship with the Australian Information Industry Association (AIIA), NEHTA chief executive Ian Reinecke says.

Dr Ian Reinecke says NEHTA remains engaged with the software industry on standards

"Most of the big players in health globally are members of the AIIA," he said after a successful vendor forum in Brisbane last week.

"Sheryle Moon, the new chief executive, has been really supportive of health as an agenda item for the AIIA, so we're making progress in that area."

….. (see the site for the full article).

This claim of a growing relationship with the AIIA really demonstrates that NEHTA has completely failed to understand the need to establish a meaningful and practical useful working relationship with the body where the true e-health expertise in Australia lies. This is not the first time that NEHTA has nominated AIIA as its way of engaging with the software industry. Is it any wonder that NEHTA was so roundly criticized at the Medical Software Industry Association (MSIA) Roundtable held a week or two ago?

The AIIA is the 'big end of town' and the peak IT industry body. It is inevitably a generalist. It has little or no understanding of the health sector. The broad picture presented by AIIA can be seen on their web-site.

“AIIA's mission

AIIA leads the ICT industry in Australia, with almost 500 member companies that generate combined annual revenues of more than $40 billion, employ 100,000 Australians and export more than $2 billion in goods and services each year.

AIIA sets the strategic direction of the ICT industry, influences public policy, engages industry stakeholders and provides member companies with business productivity tools, advisory services and market intelligence to accelerate their business growth.

If your company is serious about building your business, AIIA membership is a must. Our members have access to:

• Experience - AIIA has represented, led and connected the Australian ICT industry for almost thirty years.
• Power - ICT is a $90 billion industry, representing 4.6% of Australia's GDP.
• Representation - AIIA has almost 500 member companies employing 100,000 Australians.
• Connections - 6,000 ICT powerbrokers attend more than 100 AIIA events every year.
• Engagement - 300 ICT business leaders are our volunteers.
• Partnerships - 80% of AIIA's members are local industry companies.
• Commitment - AIIA's 7 full-time lobbyists work with government, industry and media to address the issues affecting the ICT business community.”

Clearly AIIA has no deep and focussed expertise in Health-ICT. (Indeed its election manifesto does not even mention the word) By comparison, the MSIA is a small dedicated association of about 100 members whose only role in life is Health IT. Their position and strengths in e-health should be clear from the following:

MSIA member's software accounts in Australia for approximately:

1. 95% of clinical desktops,
2. including 90% of Aboriginal health services,
3. 85% of practice management,
4. 80% of hospital PAS,
5. 100% of retail pharmacy,
6. 80% of private pathology systems,
7. 70% radiology systems, and
8. 50% of public pathology systems.

Put bluntly, NEHTA simply cannot afford to side-line this group – for if it does, nothing NEHTA wants to do will be possible – it is that simple.

Further on the article says:

"For the Cerners, the iSofts and others, when the infrastructure, standards and specifications are going to be available is a critical issue, because they are going to adopt them in their systems."

This is a fascinating remark, firstly because, according to the AIIA website (5 June 2007), Cerner is not a member of the AIIA! Secondly, I cannot imagine Cerner or iSoft (which has other worries right at the moment) being the least bit interested in NEHTA specifications. Can you? They will be interested in Global HL7 and CEN ISO Standards - that’s understandable, but NEHTA's? – hardly, given Australia is such a small part of their business.

We are also told that the use of SNOMED CT will be under a dual licensing model and that vendors that want to adopt SNOMED will need to get a licence from the SDO for access to the main parts of SNOMED that come from the SDO, and that, if they are operating in Australia they will also need a licence with NEHTA to access the Australian developed components.

This is just unwise and silly. The Australian elements are only usable in Australia. So why impose a license at all? Just make them available for anyone located in Australia to download. We are also not explicitly told that the licenses will be free and this, I think, should also be of concern.

Even more amazing is that we are now told that after three years of effort there is still a lot of development work yet to be undertaken on the medicines terminology and that NEHTA are also still trying to co-ordinate the various contributions from the Therapeutic Goods Administration (TGA) and the Pharmaceutical Benefits Scheme (PBS). Is it not appropriate to ask ‘why can't NEHTA manage to have two Commonwealth entities co-ordinate inputs?’ It might be because NEHTA, being a private company, is not part of Government, or it could be they are just not any good at what they are meant to be doing. Either way it is just hopeless.

There also seemed to be some confusion about how terminologies are used. Once developed the medicines terminology is meant to work wherever the medicines are referred to (i.e. in a message, prescription or EHR) and not be different in different applications. The fact that NEHTA is currently recruiting pharmacists on two year contracts suggests we won't see an Australian Medicines Terminology in use any time before 2009 at the earliest – with all the costs in inconvenience to user and software providers that implies.

It was also reassuring to note NEHTA thought the MSIA's working group on interoperability between clinical systems was "sensible"?. Sensible indeed! I seem to recall that defining the requirements for secure clinical messaging and interoperability was one of NEHTA’s core tasks. Now, it seems, they have vacated that space. I am left amazed and horrified. NEHTA should be co-ordinating all this – not commenting on it!

Finally, we are told that Australia is only a small part of the global E-Health Standards picture. So just what are we getting from the 60+ people that work for NEHTA? If we are just adopting and being consistent with global standards it seems to me “waste watch” needs to be called in as soon as possible.

I really wonder why this interview was given – could it be the pressure of the upcoming review of NEHTA's value and utility? On the basis of these comments, if I were them, I would be nervous if this is the best they can say in their own justification.

David.

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

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

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

The overall project context is described as follows

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

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

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

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

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

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

A full collection of the reports can be found at the

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

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

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

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

Enjoy!

David.

Vale Dr Branko Cesnik - An Australian e-Health Pioneer

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Branko, you will be missed.

Klaus Veil

HL7 Australia

Funeral Arrangements

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

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

David.

Oh Canada – A Good One!

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

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

The document can be downloaded from the following URL:

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

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

“A Vision for Health Care in Canada

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

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

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

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

It is hard to argue with the following:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

David.