WCPI 2007: The First World Congress on Pathology Informatics – A Unique Opportunity!

As a Health Informatics Community service I want to alert all readers to this first ever World Congress on Pathology Informatics!

A summary of the Congress’s contents is as follows:

“You are invited by The Health Informatics Society of Australia and the Association for Pathology Informatics to attend the first World Congress in Pathology Informatics to be held 16th-17th August 2007 immediately prior to Medinfo in Brisbane Australia.

The Congress addresses key pathology informatics issues from both a regional and technology perspective. The program is supported by a field of eminent invited speakers. On the first day practical examples of innovation across the globe by geographic region will be highlighted and on the second day there will be updates on eight of the most important themes in pathology informatics, namely:

• Automation - Leveraging pathologist's knowledge with workforce shortage; Probabilistic diagnosis; Machine learning; and Laboratory processes
• Digital Microscopy - Sharing; searching; and analysing pictures
• Omics – Will the laboratory of the future only need micro arrays, NMR spectroscopy and a Mass spectrometer; Bioinformatics in pathology
• Shared Care - Pathology's role in the shared EHR
• Disease Surveillance - Registries; Early warning systems; eNotification
• Standards Development - Messaging; Terminology; and Decision support
• Pathology Order Entry - Guideline representation; Decision support and Terminology
• Micro Electro-Mechanical Systems – Single chip analytical systems
• 
  

In addition to these invited reviews, there will be 16 twenty minute presentations of the best submitted work based on peer review.”

Invited Speakers Include:

• Prof Francis Bowling: Mater Childrens Hospital, Brisbane
• Prof Kojo Elenitoba-Johnson: University of Michigan
• Prof Sam Heard: Open EHR Foundation
• Prof Jonathan Kay: John Radcliffe Hospital, Oxford
• Prof Mark Routbort: MD Anderson Cancer Center, Houston
• Prof Ronald Tompkins: Harvard Medical School
• Prof Mehmet Toner: Harvard Medical School

Vastly more information can be found at the Congress Web Site including information on the preliminary one day introductory pathology informatics workshop on the 15^th of August, 2007.

You can register on-line from the URL above!

This will be a unique opportunity for Australians interested in the areas to rub shoulders with the best in the field.

Details of the program for the Introductory Workshop is available here:

The Main Program is available here:

Please consider if you can afford to miss this fantastic event! Missing this faculty and program may mean you never make a wonderfully interesting and profitable career change!

David.

The NEHTA Chair Completely Misses the Point!

Presumably in response to the release of the HISA Survey of NEHTA performance, earlier today, the Board Chair has released the following!

NEHTA welcomes debate on its role as peak e-health body - message from Uschi Schreiber, NEHTA Chair

7 August, 2007. The Board of the National E-Health Authority welcomes public debate about the important role NEHTA plays as the peak e-health body in Australia.

One of the objectives of the review of NEHTA commissioned by the Board and currently being conducted by Boston Consulting Group is to seek the widest possible input into determining the next steps for e-health in Australia.

The Board of NEHTA, composed of all the heads of health agencies in Australia, reaffirms the importance of NEHTA as a key driver of healthcare reform by accelerating the pace of the national e-health agenda.

There is widespread agreement across the health sector that the pursuit of e-health in a nationally coordinated strategy is crucial for Australia. Agreement about the importance of this national agenda is shared even by those individuals and organisations that may from time to time critique NEHTA’s work.

The current review of NEHTA was built into the organisation’s constitution when it was established two years ago and will assist the Board in framing the future evolution of e-health.

The outcome of the review being conducted by Boston Consulting Group will be an independent assessment of and status report on NEHTA’s progress to date. It will also make recommendations for the Board’s consideration of NEHTA’s future role and direction.

The Board of NEHTA welcomes the active engagement of interested parties during the course of the review and will take all views into account when Boston Consulting Group presents its recommendations in October.

Uschi Schreiber

Chair, NEHTA Board

In saying the BCG “seek the widest possible input into determining the next steps for e-health in Australia.” It is assumed some useful steps have been taken so far. The evidence would not really support that contention!

What this release shows is that the NEHTA Board is basically unable to appreciate how badly it has failed in serving the Australian e-Health Community in setting the directions and strategies to be followed by NEHTA. The e-Health community the Board is meant to be serving has labelled NEHTA a resounding failure but it keeps thinking that it is a good thing to “reaffirm the importance of NEHTA as a key driver of healthcare reform by accelerating the pace of the national e-health agenda.”

Then it goes on to say “There is widespread agreement across the health sector that the pursuit of e-health in a nationally coordinated strategy is crucial for Australia.” So why hasn’t NEHTA announced it is developing one? Could it be that NEHTA is not being led by its Board? I have been suggesting a plan is needed for the last 18 months and all I, and others, have got from NETHA is airy dismissals.

We also get "Agreement about the importance of this national agenda is shared even by those individuals and organisations that may from time to time critique NEHTA’s work." Sadly NEHTA Board has offered no national agenda anyone has been told about!

Last we get to the serious issue. The release says “The outcome of the review being conducted by Boston Consulting Group will be an independent assessment of and status report on NEHTA’s progress to date. It will also make recommendations for the Board’s consideration of NEHTA’s future role and direction”

Just why is the Board considering what should happen to it? It is fundamentally and existentially conflicted in doing that – and worse it doesn’t seem to get it!

NEHTA is a major problem, not a solution, and its Board is a very big part of that problem.

This release is a plea for the status quo when what is needed is root and branch change!

David.

Results of the HISA Survey of NEHTA’s Performance – The Beginning of the End for “Old NEHTA”

Today (Tuesday August 7, 2007)HISA is making public the results of its membership survey on NEHTA’s performance over the last (almost) three years since its initial instigation by the Australian Health Minister’s Council early in 2004.

The core finding from the survey (which attracted over 180 responses) is found in the conclusion. It reads as follows:

“That NEHTA's performance is not matching expectation is the major and consistent outcome of this comprehensive opinion survey evaluating the first two and half years of NEHTA's operation.

The survey is well-designed and broad-based with a good response rate and with significant effort provided by the respondents to consider and convey the issues and to provide suggestions for improvement. It cannot be easily dismissed as a factional view. This is a consistent view from informed stakeholders whose support will be required to achieve the high level objectives for health system change that were intended from NEHTA coming into existence.

Issues related to the level and manner of engagement with the health community and the style of operation and leadership were repeatedly identified. The difficult task that NEHTA has is to take the highly intelligent and independently minded members of the Australian healthcare system and get them to do something that will often mean more work, and deliver little value directly to them, at least in the short term. The hallmark of leadership in this type of environment is the ability to engage, listen and bind this diverse group together with a common purpose.

This is the critical task for NEHTA, the task at which, according to the feedback from this survey, it is not achieving. It is not really a question of technology, most of the critical technology problems have been solved to a large degree. It is an ability to engage the Australian healthcare community in an agreed plan and involve them in the standardisation process, ensuring they are the final owner and driver of the outcome.

Australia does not have the resources to engage in a UK, NHS style “top down” approach to delivering eHealth. Nor would it be the best use of those resources if we had them. We need to intelligently leverage the rich resources that we have, engage with vendors and clinical participants, decide what problems need to be addressed locally and what nationally, and most importantly bring the Australian eHealth community along on the journey.

There is no doubt that there are some talented and open people within NEHTA, but their contributions appear to be blunted by isolation from the broader Australian eHealth Community. The results of this survey are starkly clear, in spite of the talent within NEHTA, it is not performing to community and stakeholder expectations. It needs to better engage, listen, and leverage the broader talent pool in Australian eHealth. In doing this, it needs to be a participant and in some cases to lead in galvanizing both the eHealth and broader healthcare communities together in the common goal of delivering a safer and more efficient healthcare system for Australia through the application of eHealth systems and processes.

It would be better to resolve these important issues around engagement and style within the existing structures to avoid a repeat of the hiatus that occurred with the formation of NEHTA.

There is close co-operation between HISA and the Australian College of Health Informatics (ACHI) with all ACHI Fellows also members of HISA. There is a strong view from the membership of both organisations that Australia is not moving fast enough to improve health information systems and that Australia lacks an agreed and resourced plan to address this to realise the benefits that are now becoming well accepted internationally. HISA stands ready and able to contribute and support the development of this national plan.”

The full report can be found here.

What will be interesting from now is, with some really hard and credible data available as to NEHTA’s performance, is what will happen next.

On the basis that this is only one of five different submissions to the BCG review which have provided very adverse, and very similar, commentary that I am aware of, one can only hope that major change will eventuate.

The threads of:

1. Not loosing any momentum that is presently underway.

2. Developing a new plan defining who does what with whom and who is responsible for which outcomes.

3. The need for a radically different management style and approach for the current NEHTA.

Are vital. Are all present in all the submissions I have seen!

All these points, and much else, is crucial. Let us hope the outcome of the Boston Consulting Group’s NEHTA Review accurately reflects these messages.

The BCG needs to be very clear that NEHTA has spent / is planning to spend almost $200 Million by 2009 (The COAG funds $130M + operation expenses of approximately $15M + pa for four years). This is a very large sum of money and how it has been spent needs to be very carefully reviewed. (For example does NEHTA actually need a quite palatially fitted out suite on
Level 25, 56 Pitt Street, Sydney NSW 2000?) (Chatswood, Macquarie Park etc would have been as good)

Just look at how the Royal Exchange Building portrays itself!

“With frontage to three streets this prominent corner position enables the Royal Exchange Building to take advantage of excellent natural light and good harbour views to the north-east particularly from the upper levels. The high rise floors present magnificent northerly and easterly views including Circular Quay, the Opera House and the Botanic Gardens. To the west the aspect is no less spectacular enjoying expansive views of the City and beyond creating an evocative backdrop particularly at sunset.

The central CBD location is only a short distance from Wynyard Railway Station and the bus ferry and rail transport at Circular Quay. Equally close in all directions are some of Sydney's leading international five star hotels, and a wide selection of Sydney's finest shops restaurants and entertainment. “

Nice spot if you can afford it – for more amazing information on how money is being wasted go to:

http://ebuilding.com.au/56pittstreet,sydney/jadehttp.dll?EBDWebsite_002

Let us also hope DoHA recognises the appalling conflict the NEHTA Board finds itself in – being the recipient of a consultant report which is very likely to suggest their oversight of NEHTA has been highly unsuccessful – at best. They should take the management of this project back to the Department itself and so free the consultants to do their job fearlessly and honestly.

I must say the work presented here re-assures me I have not been wasting my time pushing for major change in NEHTA.

Wait now for the “Empire to Strike Back”. The attempts at spin, backdoor attacks on the credibility of all those involved, denial of the validity or the survey and claims of bias on the part of the authors will be fascinating to watch.

I suspect we will also hear claims – we are doing great, this all just takes time so give us more time (duration unspecified) and we can prove how wonderful we really are!

In order to counter all this one should ask the following question. Just how many commercial vendors have actually signed up to use the NEHTA’s patient and provider identity services and what will this service cost into the future when the initial funding is used up? I think the answer is none and no-one knows.

Another issue, now it is clear that major change at NEHTA is warranted is the status of all those staff hired on two and three year contracts. Some will surely be in areas now seen as not strategic or useful. Even if there are 20 of the 100 or so staff who have to be paid out (given $250,000 per person in total employment costs would be usual for a two year contract) that could be $5.0 million paid, after the event, on wasted staff.

Further, longer than six month, recruitment by NEHTA should obviously be deferred until clarity is available.

I commend the survey to you for a very close read – it is really good to see the truth out once in a while!

David.

Press Commentary is now available:

1. MIS Australia

2. Australian IT

D.

A Tiny Rumour from Crikey.Com.au. – For Your Reading Pleasure

“Victorian DHS Healthsmart over budget?

How do you keep a program running when it is over budget, has delivered little and hospitals don't have the money to use its systems? If you give the hospitals the money the cost will be allocated against the program. If you provide the systems the costs will be allocated against the program... but if you give the hospitals an interest free loan to pay for the systems that they are supposed to pay back in five years the costs can be hidden and who will be around then anyway?”

The answer to that question - as we see from yesterday's post is virtually nobody!

I wonder is it true?

Not often e-health gets a run in Crikey. Good on them and thanks for this tit-bit!

It almost sounds like another e-Health initiative I can think of. Stay tuned for huge breaking news in that domain tomorrow.

David.

Useful and Interesting Health IT Links from the Last Week – 05/08/2007

Again, in the last week, I have come across a few reports and news items which are worth passing on. Not as rich a pickings this week as I am dying from the current flu!

These include first:

http://www.intergovworld.com/article/1cf1b5d40a01040801c4b5793333f8a2/pg1.htm

Blocks of SOA: Building services with common symbols

By: Rosie Lombardi, CIO Government Review

(08-01-2007)

Service-oriented architecture (SOA) can demolish the status quo. Decades of siloed system design have left most government organizations with antique, rickety systems that don't play well with others. By putting new SOA wrappers on old proprietary applications, modular interfaces can be built, shared, linked, reused and recombined as needed, to create an infinitely interoperable IT utopia.

No need to rip and replace old systems; instead, they can be refurbished and extended internally and even externally via the Web. This is where SOA shows promise well beyond rejuvenating legacy enterprise systems, says Bill St. Arnaud, senior director of advanced networks at Ottawa-based CANARIE Inc.

"SOA is now seen as a key component in a broad range of fields beyond enterprise IT: chemistry, biology, everything," he says. "Whether it's a traditional payroll application or radio telescope research, it makes sharing, mapping and transferring data, and creating new mash-ups, simple."

SOA can also have a profound impact on business processes. Many complex processes that require human back-and-forth can be automated as SOA-based Web services, which in turn can invoke other Web services, and then others, throughout the service chain. "If GM orders a phone line from Bell Canada [for example], it has to be validated, checked, tested, delivered and invoiced by many people," says St. Arnaud. Instead, all the specialized steps in the transactions can be itemized, agreed in a contract, and automated as interlinking Web services between both companies.

Take-up of SOA is stronger in more competitive markets, he says. In the U.S., about 70 per cent of companies say they plan to invest in it over the next two years, according to IDC Canada research. In sluggish Canada, the figure is 40 per cent, with the public sector lagging still further behind the private sector.

Building this SOA utopia won't be easy. There are many impediments, ranging from making the business case to fix systems that aren't entirely broken to governance and liability issues to standards wars, notes St. Arnaud. Nevertheless, SOA is slowly but surely creeping into many areas of Canadian government.

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

This is a series of five articles which discuss SOA and then provide a focus on the Health Sector and SOA. Well worth a browse!

http://www.computerworld.com.au/index.php?id=57791847&eid=-44

Issues you need to know about software-as-a-service

12 things to think about before choosing a software-as-a-service application

Jon Brodkin (Network World) 02/08/2007 15:02:11

Software-as-a-service is just about the most-discussed topic in software these days. It'll probably save you money and lead to faster implementation, but it's not always a no-brainer. Here are 12 things to think about before choosing a software-as-a-service application.

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

This is another perspective on the same topic – again worth a look.

Second we have:

http://www.zdnet.com.au/news/security/soa/ANZ-and-Canberra-in-smartcard-deal/0,130061744,339280896,00.htm

ANZ and Canberra in smartcard deal

Brett Winterford, ZDNet Australia

03 August 2007 01:26 PM

ANZ Bank has struck a deal with the federal government which will see its business customers issued smartcards for making secure transactions with government departments.

Under an arrangement struck between ANZ and the Department of Industry, Tourism and Resources (DITR), a "handful" of select ANZ business customers will be piloting the use of chip cards containing an IdenTrust digital certificate to authorise such government transactions as applying for grants, licences and permits; for signing and submitting government tenders and contracts; for meeting reporting requirements for importers/exporters; or even a transaction as simple as registering a business or company name or applying for an ABN.

The smartcard pilot is a part of a wider federal government initiative called the VANguard program, aimed at providing validation and authentication solutions between government and industry in an attempt to streamline communications and cut red-tape.

The program was announced with AU$29.6 million of funding in the 2006/07 budget and is expected to be complete within the next two years.

A spokesperson for the Minister for Small Business, Fran Bailey, said that at present, organisations can lodge documents online with government departments, but complications arise whenever they need to authenticate the document.

"You can lodge them online, but often you need to physically sign the document and mail or fax it in," the spokesperson said. "A lot of online stuff has fallen down because you still need physical signatures [to verify identity]."

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

Seems we are inventing yet another electronic Identity Management System. I wonder where this fits in with the work on the Access Card, the Document Verification System and the Passport Office. We will be told in due course I guess. This zone is almost as strategy free as NEHTA!

Third we have:

http://www.theaustralian.news.com.au/story/0,25197,22180055-23289,00.html

Patients are ill served by revolving door for health CEOs

COMMENT: Mike Daube | August 04, 2007

TRADITION has it that ministers are ephemeral creatures who come and go, while bureaucrats -- especially at senior levels -- last for-ever. Ministers are there for the short term, to determine policy, set directions, make key decisions and provide political leadership. Departmental heads provide organisational leadership, expert advice and continuity.

In the Westminster system, as described by one textbook of bygone years, "... few things are so permanent as the tenure of established posts in the Civil Service". Further, "this permanence of the established Civil Service ... is of inestimable advantage. Without it, we might have to endure a civil service as amateurish and transient as many ministers are".

That may have been true once, but no longer -- and certainly not in health.

Federally, Tony Abbott -- no amateur -- replaced Kay Patterson in October 2003, and last year claimed victory at the National Press Club, saying: "Largely neutralising health as a political issue has been one of the Government's big political achievements".

Around the states and territories, the veteran health ministers are Victoria's Bronwyn Pike, who has held her position since November 2002 and Western Australia's Jim McGinty, appointed in June 2003. They are followed by Queensland's Stephen Robertson (July 2005), South Australia's John Hill (November 2005), the ACT's Katy Gallagher (April 2006), Tasmania's Lara Giddings (May 2006), the Northern Territory's Chris Burns (September 2006) and NSW's Reba Meagher (April 2007).

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

This is a really important article as it explains one of the key reasons for the failure of e-Health in Australia. Absolute short-termism on the part of pretty much the whole bureaucracy. Implementation of complex systems in the Health Sector requires stable long term and committed leadership..we simply don’t have it!

Fourth we have:

http://www.ihealthbeat.org/articles/2007/7/31/EHRs-Media-and-Statistics-Misinterpreted-Results-Skew-Understanding.aspx?ps=1&authorid=1572

EHRs, Media and Statistics: Misinterpreted Results Skew Understanding

by Jane Sarasohn-Kahn

"Electronic Health Records Didn't Improve Quality of Outpatient Care"

"Electronic Health Records Don't Lift Care"

"Electronic Records Don't Always Improve Care"

"No Quality Benefits Seen with Electronic Health Records"

"Electronic Medical Records May Not Live Up to Hype"

So said some of the newspaper headlines about the July 9 Archives of Internal Medicine paper, "Electronic Health Record Use and the Quality of Ambulatory Care in the United States."

When I read the news coverage emanating from the study, it caught me -- and I suppose many of your readers -- off guard. I'm not one to bash the mass media, but reporters got this latest study on electronic health records and outcomes wrong. Journalists need a quick course in statistics, and perhaps simple reading mastery, to know the difference between causality and simple association.

A highly credible and switched-on team from Harvard and Stanford universities wrote the study, which the Agency for Healthcare Research and Quality funded. For the study, researchers studied data from the 2003 and 2004 National Ambulatory Medical Care Survey published by CDC. The data set detailed EHR use coupled with 17 ambulatory care quality indicators. These indicators covered medical management of common diseases, antibiotic prescribing, preventive counseling, screening tests and other services. According to the analysis, physicians' performance on these quality indicators was not associated with the "use" of an EHR system.

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

Another take on just why the recent article may have been a half truth at best!

Fifth we have:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070731/FREE/70730002/1029/FREE

CPOE users rank unintended consequences

By: Andis Robeznieks / HITS staff writer

Story posted: July 31, 2007 - 5:59 am EDT

In an in-depth study of hospitals using computerized provider order-entry systems, it was found that most institutions with fully implemented CPOE have not been using it that long but are using it intensely—despite the occurrence of eight common unintended consequences, which researchers said can be managed if healthcare teams anticipate and prepare for them.

In a report in the July issue of the Journal of the American Medical Informatics Association, those eight unintended consequences were listed in order of their importance, according to a survey of 176 CPOE-using hospitals: issues involving more work or new work, workflow issues, never-ending demands for new software, equipment and training, paper persistence, communication issues, emotional issues, new kinds of errors, changes in power structure and overdependence on technology.

The effect of the consequences can be positive or negative depending on one's point of view, particularly with the consequence of shifts in the institutional power structure.

"What we had seen were physicians definitely feeling they were losing autonomy," said Joan Ash, an associate professor and vice chairwoman of the Oregon Health and Science University School of Medicine's department of medical informatics and clinical epidemiology. "But the people answering our questions didn't think power shifts were going on—or, at least, they didn't feel that they were that important. Maybe the people who were answering questions didn't feel the shift because they were gaining power, and perhaps it's harder to realize you're gaining—instead of losing—power."

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

Interesting article on the ways Clinical Physician Order Entry (CPOE) can have un-intended consequences. Well worth a close read.

Lastly we have:

http://health-care-it.advanceweb.com/common/Editorial/Editorial.aspx?CC=93847

Ten Tips for a Community Health Information Exchange.

By Leigh Burchell

The vast majority of clinicians are interested in using technology such as electronic medical records (EMRs) to better manage patient data and improve access to clinical information. But these technology-savvy clinicians still aren’t able to access a large amount of patient information, including EMRs from non-compatible facilities. Clinicians know that having access to this information when diagnosing or treating their patients would lead to improvements in care. However, while clinicians recognize the value of health information exchange (HIE), many do not know how to initiate a conversation about establishing a local health information network in their community.

In an attempt to spark dialogue, The Center for Community Health Leadership advisory board, which includes industry-recognized doctors and experts, developed the following guidelines for the creation of community-based HIE. These tips can be referenced by communities preparing to implement technologies for HIE, to ensure that the results will be positive for all parties involved, including hospital-based physicians and caregivers, community clinicians, home health organizations and, most important, community residents.

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

A useful summary of the steps that should be taken in establishing a Health Information Exchange in the US environment. A range of useful points that are relevant in the Australian situation.

All in all not a bad lot to start the week given my tatty state of health!

More next week.

David.

Important Information Alert!

The following important articles are available on line for free download only until about the 14^th August 2007. After that they will be pay-per-view access only (unless, of course, you are a subscriber to Health Affairs).

Health IT And The Santa Barbara County Care Data Exchange

Table Of Contents

The Santa Barbara County Care Data Exchange: What Happened?
Robert H. Miller and Bradley S. Miller

From Santa Barbara To Washington: A Person's And A Nation's Journey Toward Portable Health Information
David J. Brailer

Retrospective: Lessons Learned From The Santa Barbara Project And Their Implications For Health Information Exchange
Jonah Frohlich, Sam Karp, Mark D. Smith, and Walter Sujansky

Another Lesson From Santa Barbara
Donald L. Holmquest

Health Information Exchange: 'Lex Parsimoniae'
J. Marc Overhage

I suggest all those interested in Health Information Networking pick up copies before they start costing money!

David.

Dr Oliver Frank – Experienced GP and Health IT Expert – Provides a Submission to the NEHTA Review.

I had a nice e-mail from Dr Frank this morning providing more transparency as to what the NEHTA review is hearing – this from a GP perspective. I quote:

Dear David,

I am writing to say that you may put my submission on your Web site. As I said, it was written in a very short time that I had, and isn't quite as 'respectable' as one might wish in terms of elegance, research and comprehensiveness, but I agree that it is important to put as much out in public as possible to try to make the BCG review process as useful as possible.

--

Oliver Frank, general practitioner

255 North East Road, Hampstead Gardens, South Australia 5086

Phone 08 8261 1355 Fax 08 8266 5149 Mobile 0407 181 683

What follows is the view of NEHTA from someone who has been involved in GP Computing for many years. I quote:

-----

Subject: Submission to NEHTA review

Date: Wed, 18 Jul 2007 07:55:15 +0930

From: Oliver Frank

Reply-To: oliver.frank-at-adelaide.edu.au

To: nehta_review-at-bcg.com

I am responding to the invitation to send a submission. I am a GP and full time partner in a group general practice. I have been involved in health informatics since 1985.

My qualifications are MBBS, FRACGP, PhD.

A brief selection from my CV:

2006 - Board member and Deputy Chair, Adelaide North East Division of General Practice

2004 - Member, Quality Practice Committee of the Adelaide North East Division of General Practice

2004 Member, Quality Care Working Group of the General Practice Computing Group

2003 Member of Scientific Program Committee, Health Informatics Conference 2003 & RACGP 12th Computer Conference

2002 Representative of South Australian Divisions of General Practice on Generational Health Review of the South Australian health system

2001-2002 Chairman, RACGP National Informatics Committee

2000 - 2006 Representative of South Australian Divisions of General Practice on the Clinical Information System (OACIS) Enterprise Wide Steering Group of the South Australian Department of Human Services

1999 - 2002 Representative of the Royal Australian College of General Practitioners on the Management Committee of the General Practice Computing Group

1999 - 2007 Urban Divisions’ representative on the Informatics Advisory Committee of South Australian Divisions of General Practice Inc.

In answer to your questions:

1. NEHTA’s effectiveness in meeting its objectives during the two years since its inception, including:

a. The consistency of NEHTA’s current role and function with its objectives as laid out in the NEHTA constitution[1] – “Has NEHTA achieved what was intended for it?”

I believe that NEHTA has largely failed to achieve what was intended for it.

b. The appropriateness of NEHTA’s objectives, given the needs of e-Health development in Australia - “Was NEHTA tasked with the right objectives in the first instance”

NEHTA's objectives were reasonably appropriate.

c. NEHTA’s goals, strategies and work plan, including any gaps or overlaps with the work of other bodies

NEHTA's strategies and work plan have failed to produce very much useful output to date and therefore must be judged as poor.

d. Progress achieved in deliverables and outcomes, especially with regard to the development of standards and the establishment of core information infrastructure for e-Health.

NEHTA has delivered very little in exchange for resources that it has received. It has produced only one useable or potentially useable standard that I know of and it and it has established no core infrastructure that I know of for e-Health - in fact, it has actually retarded progress because various other players have been holding up projects while they have been waiting and waiting for NEHTA to produce what it was supposed to produce and that it said that it intended to produce.

e. NEHTA’s structure and governance arrangements

NEHTA's structure is poor. The State health CEOs and other non-informatics experts on the Board of NEHTA are the wrong people to be running e-Health developments. The medical and other health professions are not represented or consulted adequately or at all. I asked NEHTA to give me a list of GPs with whom it had been working. NEHTA refused to do so and I still don't know.

f. The consultation and communication process NEHTA has undertaken, including:

§ The engagement process that has been conducted

There has been no effective engagement process. For example, I attended the MSIA Round Table meeting in Sydney on 22nd May 2007, to which NEHTA had been invited. NEHTA did not attend this most important meeting at which the vendors and developers who supply the software used by 95% of health professionals in Australia were working out their role in the future of health informatics in Australia.

§ The completeness and quality of the content that has been communicated

The quality of the content that has been communicated has been very poor. A lot of it has been presentations by the CEO and others that are simply promotions for what NEHTA is going to do. Much of the content that should have been in formats useable by information professionals to build information systems has been in amazingly non-professional and incompetent text files, spreadsheets and the like.

§ The outcomes that have been achieved as a result of consultation

g. The funding for, and value for money achieved by NEHTA, including:

§ The balance of resources committed to different activities and objectives

I don't have a clear enough picture about this to comment.

§ The level and mix of sources of funding

Little has been achieved from consultation because there has been so little consultation by NEHTA! The value for money has been very low.

2. Possible roles for NEHTA or a similar entity in the context of future e-Health reforms, including:

1. Roles and responsibilities for existing players and/or potential new players, including NEHTA, in e-Health reform going forward In the future, the national organisation for the development of health informatics in Australia must much more involve the health professionals who are actually caring for patients. It will be important particularly to seek to involve those health professionals who also have knowledge, skills, experience and/or qualifications in health informatics. NEHTA's heavy focus to date on public hospital systems and public health systems, resulting largely from the composition of its Board, has been undesirable and inappropriate. The new national organisation for the development of health informatics in Australia will need to give equally as much attention to the informatics needs and realities of health professionals working outside public hospitals, where a lot of the gains from e-Health are to be made.

2. Priority next steps in delivering e-Health objectives

a. Help all health professionals to stop writing on paper.

b. Get all parts of the health system exchanging clinical information electronically.

3. Vehicles and sources for funding the next steps

Divisions of General Practice are well-placed, if properly resourced, to help to get GPs using electronic information systems more effectively. Other health professionals may need other vehicles or perhaps there should be created an organisation that helps all health professionals to increase their use of electronic clinical information systems – this could be a teaching arm of the new national organisation for the development of health informatics in Australia.

Commonwealth and States together need to fund these steps. The Commonwealth/State divides, tensions and cost shifting must be addressed and sorted out.

4. Potential governance models

Governments and the new national organisation for the development of health informatics in Australia will need to work closely with health professionals and their professional organisations.

5. Ongoing operation and maintenance of standards and infrastructure established by NEHTA

NEHTA has established only one standard that I know of that is of any relevance, and it has established no infrastructure that I know of, so asking about 'ongoing operation and maintenance of standards and infrastructure established by NEHTA' is hardly relevant currently.

In summary, my experience and opinion about NEHTA is that it was wrongly structured for its tasks, that it has conducted its business in a secretive dictatorial largely non-consultative manner, and that it has so far produced very little of any real use to the people, patients and health professionals in Australia.

I am happy to discuss any of this with you at any time.

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Oliver Frank, general practitioner

255 North East Road, Hampstead Gardens, South Australia 5086

Phone 08 8261 1355 Fax 08 8266 5149 Mobile 0407 181 683

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Thanks for that Oliver!

David.

A Problem that Needs to be Pre-empted and What a Strange Company NEHTA Is!

This article is a two-parter made up of two short comments:

The first comment is prompted by a number of e-mails I have received commenting on the unsatisfactory nature of the management framework put in place for the Boston Consulting Group (BCG) review of NEHTA.

One correspondent made the point elegantly if a little bluntly:

“Your own analysis ( See AusHealthIT Blog on 31/07/2007 ) agrees that governance is a major issue with NEHTA.

The NEHTA Board is the sole recipient of the BCG review material – and on the basis that this material will be highly critical (as we know many submissions are) – what is to happen?

Is the NEHTA Board simply going to acknowledge that there is a broad consensus in the Australian e-Health Community that the NEHTA Board has been crucial factor in NEHTA’s underperformance and then start fixing itself up in an open and transparent way and order itself to self-destruct? Yes, as sure as those things with curly tails are going to suddenly start to fly unaided through the air!”

A failure of the NEHTA Board to face up to the shortcomings of the entity for which they are accountable needs to be pre-empted.

Ideally this would involve full public disclosure (un-edited) of all the BCG deliverables associated with the NEHTA review. Recognising that this is a mite unlikely….

The second best way for this to happen would for the BCG to make public – with the agreement of the authors and their organisations – as much of the submissions it has received as possible so that everyone can be assured that due note is taken of all views (both positive and negative). This disclosure should also be combined with – at the least – a listing of the other information sources (interviews, research references etc) as well as a final summary of recommended outcomes and recommendations and the NEHTA Board Response.

It needs to be said, quite explicitly, that the NEHTA Board has created this conflict of interest and it is up to the Board to publicly and transparently fix it. No blame should be apportioned to BCG, except maybe to suggest that they should not have taken the engagement with the governance as it was. Even in the NEHTA constitution it was poor drafting to have the Board organise its own existential review.

Publication would allow all those with an interest to form a view as to how well the review has been conducted and how open and transparent the NEHTA Board has been in responding to the recommendations.

Associated with suggesting this as a useful outcome I would again encourage all who have made submissions to BCG to make them publicly available via the web – my web-site or yours is your choice!

Creators of submissions should recognise they are doing a favour to both NEHTA and the BCG by spending time creating submissions and that there is no doubt the submissions are fully owned and disclosable by the creators or organisations as they choose.

If the fundamental issue of existential conflict that exists in this review is not properly addressed (by full disclosure of all the BCG reports related to the review by the NEHTA Board and a written Board Response to the Review) I for one would be concerned we will never know what was really said.

On a slightly different but related tack I came upon the NEHTA Ltd Articles of Incorporation a few weeks ago. They are interesting in all sorts of aspects – especially the point that NEHTA Ltd Members are the six States, two Territories and the Commonwealth. I wonder how many other companies have these members – maybe a lawyer can let us know?

The document is found here.

David.