The Future of Regional Health Information Organisations in the USA.

This press release appeared last week – and is a useful survey of where the RHIO movement is in the USA.

http://www.healthaffairs.org/press/novdec0708.htm

New Survey From Harvard Researchers Casts Serious Doubt On Future Of Regional Health Data Exchange

Despite The Hype, Many Regional Health Data Networks Fail; Those That Survive Tend To Have Narrow Participation And Limited Information Exchange

Bethesda, MD -- The widely held vision of achieving electronic clinical data exchange across the United States is far from a reality, with few organizations facilitating such exchange and many failing in the process, says a new Web Exclusive study by Harvard researchers published today by Health Affairs. http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.1.w60

The study, based on a 2007 survey of 145 regional health information organizations (RHIOs), is a comprehensive assessment of the state of electronic health data exchange in the U.S. Electronic health data exchange between hospitals, doctors’ offices, labs, and other clinical settings has been hailed as the key to improving the quality, efficiency, and coordination of care.

But the new survey, funded by Harvard’s Program for Health Systems Improvement, identifies serious barriers to achieving this goal with the current approach.

RHIOs Limited In Spread And Size

At the time the survey was conducted, nearly one-quarter of the 145 RHIOs were defunct. Only twenty initiatives were deemed to be of at least modest size and exchanging some clinical data. Five of those RHIOs exchanged data for a specific population, such as Medicaid enrollees, the uninsured, or patients with a chronic illness like diabetes. Only fifteen RHIOs exchanged clinical data across a range of patient populations.

“These findings suggest that nationwide electronic clinical data exchange will be much harder than what many people have envisioned,” said lead study author Julia Adler-Milstein, a doctoral candidate in health policy at Harvard University. “The expectation has been that we will have RHIOs throughout the country that bring together all the providers in their region and engage in comprehensive data exchange. In reality, we’re seeing few established RHIOs, and those that are established only have a small number of participating groups exchanging a narrow set of data.”

Adler-Milstein’s coauthors are Andrew McAfee, an associate professor at the Harvard Business School; David Bates, chief of general medicine at Brigham and Women’s Hospital, and Ashish Jha, an assistant professor at the Harvard School of Public Health.

Most successful RHIOs started by focusing their efforts on exchanging test results from laboratories and imaging centers, Adler-Milstein noted, adding that that’s where she believes the clearest return on investment lies. Exchange of other data -- such as clinical notes -- is much more difficult to achieve, partly because cost savings from such initiatives are less tangible, she said.

Sustained Funding Sources Needed

Establishing a successful RHIO is not only hard work; it’s expensive, with significant up-front costs, Adler-Milstein remarked. The current approach to establishing RHIOs tends to rely on small start-up grants with the hope that participants will be willing to pay the RHIO once data exchange is initiated. The survey findings suggest that some RHIOs are struggling with the transition to self-sufficiency, as eight of the twenty moderate-size RHIOs reported that they continued to depend heavily on grants. In contrast, nine never received grant funding. Thirteen RHIOs said that they collected recurring subscription or transaction-based fees from participants to stay in operation.

“If we want RHIOs to attain the vision of comprehensive health information exchange, we need to increase our investments in them,” Adler-Milstein said. “Otherwise, many of these RHIOs will be unable to sustain themselves under the current market-oriented approach.”

Other facilitators of success include the following:

-- Data standards than enable different computer systems to “talk” to each other
-- Health data privacy and security safeguards
-- Community buy-in, including overcoming health care providers’ competitive concerns
-- Financial incentives to provide high-quality, cost-effective care

“While many RHIOs are struggling, some have figured out a way to sustain themselves and that is a reason for hope,” said coauthor Ashish Jha. Both authors suggest that meaningful financial incentives for high-quality, efficient care--the so-called “pay-for-performance” (P4P) programs--will help advance clinical data exchange. “Either we have to create the right market conditions or have much greater public investment, but the vision of a national health information network is unlikely to come to fruition without one or the other,” said Jha.

---- End Release

This paper is an important contribution to understanding just how things are going with the RHIO movement.

David.

The USA Plans to Refine its National E-Health Strategy.

The following appeared a few days ago. All I can say is what a great idea!

ONC Will Issue Updated HIT Strategy in 2008, Says Friedman

By Cindy Atoji

December 11, 2007 | Charles Friedman, newly appointed number-two man at the Office of the National Coordinator for Health Information Technology (ONC) said yesterday than ONC will soon release a five-year strategic plan detailing the national health-IT agenda. Friedman wouldn’t reveal specifics of the plan, but said he hopes it will be submitted for federal review on Dec. 21 and be ready for release in 2008.

This will be the first release by ONC of a coordinated review of its work and that other of other federal agencies since 2004 when then ONC chief David Brailer issued the first strategic framework. Friedman spoke with Digital HealthCare & Productivity about his role and priorities at the ONC as second-in-command to Robert Kolodner. Prior to joining ONC, Friedman worked in research informatics and information technology at the NIH and also established a center for biomedical informatics at University of Pittsburgh.

DHCP: What are your priorities for ONC in the coming year?

Friedman: The number one priority right now is development of our strategic plan. The Executive Order, which created the ONC, called for the creation of a strategic plan, which is a hard thing to do in this very quickly moving field. We are the in process of creating a plan and hope to send it into the federal clearance process on Dec. 21. I’m not sure if we’re going to make it, but we’re going to do everything we can to make this deadline. The plan is shaping up nicely and will be a valuable document not only for office but the government and the nation as a whole when it’s finished.

DHCP: So what’s in this plan? Can you give us a preview?

Friedman: This new strategic five-year plan has a horizon of 2012 or 2014. It will take the spirit of the previously released framework as well as the activities and accomplishments achieved across many agencies along the way and project them forward to create a vision in pursuit of the goal of interoperable health-IT to fulfill the vision of Executive Order for interoperable health-IT by 2014.

Finish reading the interview here:

http://www.digitalhcp.com/hitw/newsletters/2007/12/11/onc-charles-friedman/

This seems to me to be exceptionally good news. Hopefully the document will analyse the progress that has been made over the last four years objectively and assist in identifying the factors that have contributed positively, and negatively, to the current situation.

An improved approach in a number of areas seems to be needed if we are to see the 2014 target even partially achieved.

The following press release makes it clear there are some issues to be addressed

http://www.healthaffairs.org/press/novdec0708.htm

New Survey From Harvard Researchers Casts Serious Doubt On Future Of Regional Health Data Exchange

Despite The Hype, Many Regional Health Data Networks Fail; Those That Survive Tend To Have Narrow Participation And Limited Information Exchange

Bethesda, MD -- The widely held vision of achieving electronic clinical data exchange across the United States is far from a reality, with few organizations facilitating such exchange and many failing in the process, says a new Web Exclusive study by Harvard researchers published today by Health Affairs. http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.1.w60

The study, based on a 2007 survey of 145 regional health information organizations (RHIOs), is a comprehensive assessment of the state of electronic health data exchange in the U.S. Electronic health data exchange between hospitals, doctors’ offices, labs, and other clinical settings has been hailed as the key to improving the quality, efficiency, and coordination of care.

But the new survey, funded by Harvard’s Program for Health Systems Improvement, identifies serious barriers to achieving this goal with the current approach.

RHIOs Limited In Spread And Size

At the time the survey was conducted, nearly one-quarter of the 145 RHIOs were defunct. Only twenty initiatives were deemed to be of at least modest size and exchanging some clinical data. Five of those RHIOs exchanged data for a specific population, such as Medicaid enrollees, the uninsured, or patients with a chronic illness like diabetes. Only fifteen RHIOs exchanged clinical data across a range of patient populations.

“These findings suggest that nationwide electronic clinical data exchange will be much harder than what many people have envisioned,” said lead study author Julia Adler-Milstein, a doctoral candidate in health policy at Harvard University. “The expectation has been that we will have RHIOs throughout the country that bring together all the providers in their region and engage in comprehensive data exchange. In reality, we’re seeing few established RHIOs, and those that are established only have a small number of participating groups exchanging a narrow set of data.”

Adler-Milstein’s coauthors are Andrew McAfee, an associate professor at the Harvard Business School; David Bates, chief of general medicine at Brigham and Women’s Hospital, and Ashish Jha, an assistant professor at the Harvard School of Public Health.

Most successful RHIOs started by focusing their efforts on exchanging test results from laboratories and imaging centers, Adler-Milstein noted, adding that that’s where she believes the clearest return on investment lies. Exchange of other data -- such as clinical notes -- is much more difficult to achieve, partly because cost savings from such initiatives are less tangible, she said.

Sustained Funding Sources Needed

Establishing a successful RHIO is not only hard work; it’s expensive, with significant up-front costs, Adler-Milstein remarked. The current approach to establishing RHIOs tends to rely on small start-up grants with the hope that participants will be willing to pay the RHIO once data exchange is initiated. The survey findings suggest that some RHIOs are struggling with the transition to self-sufficiency, as eight of the twenty moderate-size RHIOs reported that they continued to depend heavily on grants. In contrast, nine never received grant funding. Thirteen RHIOs said that they collected recurring subscription or transaction-based fees from participants to stay in operation.

“If we want RHIOs to attain the vision of comprehensive health information exchange, we need to increase our investments in them,” Adler-Milstein said. “Otherwise, many of these RHIOs will be unable to sustain themselves under the current market-oriented approach.”

Other facilitators of success include the following:

-- Data standards than enable different computer systems to “talk” to each other
-- Health data privacy and security safeguards
-- Community buy-in, including overcoming health care providers’ competitive concerns
-- Financial incentives to provide high-quality, cost-effective care

“While many RHIOs are struggling, some have figured out a way to sustain themselves and that is a reason for hope,” said coauthor Ashish Jha. Both authors suggest that meaningful financial incentives for high-quality, efficient care--the so-called “pay-for-performance” (P4P) programs--will help advance clinical data exchange. “Either we have to create the right market conditions or have much greater public investment, but the vision of a national health information network is unlikely to come to fruition without one or the other,” said Jha.

----- End Release

Given all the known issues in Australia, and at the risk of sounding like a cracked record it would be great if Ms Roxon decided 2008 was a god year for Australia to also have a plan!

David.

I Wonder if NEHTA has a Plan “B” or Should They Be Out of the Loop?

As regular readers will know the NEHTA Board announced the following a few days ago.

“The Board of NEHTA also endorsed a business case for developing a national platform for personal electronic health records to be put to the Council of Australian Governments (COAG) early next year.”

This led me to start thinking what were the possible outcomes of NEHTA submitting this business case to COAG, and secondly should they manage anything at-all?

It seems to me there are five reasonably possible routine outcomes – and the required one!

First, COAG could endorse the Business Case and provide the funding that is requested for the four year project.

This seems to me to be a very unlikely outcome – in part for the reasons outlined in the previous blog – see here – and in part because COAG would want, at the very least, to make sure there are regular milestones and conditional benchmarks applied to the flow of funds and other resources.

Additionally, if COAG has its wits about it, it may say it would like this project to be positioned within the context of a National E-Health Strategy to ensure all the necessary ducks can be properly aligned.

Second, someone on COAG may remember HealthConnect, and suggest that as well as the present Business Case, a review of previous attempts – along with more detailed planning – be undertaken to firm up the project details, benefits, stakeholder consultation etc such that after that work has been successfully completed more substantial approval may be forthcoming.

This seems to me to be a much more likely outcome.

Third COAG may approve, say, an initial twelve months of funding and other resources, set some milestones and benchmarks and look forward to a progress report in a year’s time. This seems to me to be very unlikely as COAG will recognise the political risk of starting something like this and then having to stop it if it does not look to be going well – exactly as happened with HealthConnect Version 1.

It also is likely there will be sufficient corporate memory in the Commonwealth Department of Health and Ageing (DoHA) that there would be resistance to a project of this scale and risk setting out without very considerable proof of concept work being done.

There would be a lot of problems if, at 12 months, things were not going well..as is more than possible

Fourth, COAG might say that it is not comfortable that all the necessary pre-work has been done and ask for a more detailed business case to be presented for the next meeting or two. Given the poor view of the Boston Consulting Group on the readiness of the Shared EHR proposal and the inadequate level of public and industry consultation that has been undertaken this seems quite likely.

So, one way or another, I suspect a good deal more work and consultation will be requested before approval is given.

Lastly, of course, it is also possible that COAG will say that this looks too complex, difficult and risky for now, and defer the whole thing indefinitely. Go back a develop a plan that addresses these concerns and we will consider it much later! This is not impossible, but given that all the State Health CEO’s have agreed to move forward, and have NEHTA come to COAG, it is hard to see the Ministers delivering such a firm knockback.

I am no prophet, and I am sure other nuances are possible, but if I were NEHTA I would not have embarked on this without a carefully thought out Plan B. Without such a plan this could turn very messy and many may find themselves embarrassed. I wonder if it exists and what it is? I find it hard to believe COAG will just wave something like this through without some considerable review and discussion!

If NEHTA does not have a decent secondary way forward – that avoids much of the risk and complexity of the apparently envisaged Shared EHR – E-Health in Australia could languish for a long while. To hear what NEHTA and those they report to really need to do, read on!

The big picture alternative, which I much prefer, is that totally new governance structures for Australian E-Health will emerge, NEHTA will go back to doing what it should do – enabling infrastructure improvements and Standards – and a major policy and technical implementation – managed by experts - will develop – all I can do is hope this is the real outcome of COAG.

This is the outcome we really need – and this is what needs to happen now! The NEHTA Business Case must be abandoned and better more strategic brains must take over! As they say those who “Fail to plan, plan to fail”. By pretending they can proceed without an explicit articulated plan and new governance, NEHTA shows itself for the techo driven, non strategic, organisation it is.

NEHTA is not the organisation to deliver the Business Case for ( and the actuality of ) the Shared National EHR. It is as simple as that! That needs to be a done by culturally richer, better resourced and much more competent entity.

David.

NEHTA is Planning an Ill Conceived E-Health Catastrophe!

Given this could be the most important blog I write this year, I felt it needed to be started by a relevant quotation. My chosen quotation is 'Those who cannot remember the past are condemned to repeat it.' This is one of the notable quotations from George Santayana and can be found in the work entitled Life of Reason, Reason in Common Sense, Scribner's, 1905, page 284.

Why is this relevant? Let me explain.

On the day the NEHTA Review by the Boston Consulting Group (BCG) was released the Australian published an article – clearly prepared well in advance – informing an unsuspecting populace that they were about to all have a Shared Electronic Health Record (Shared EHR) made available to them within four years, if they wanted one! Clearly an attempt to distract from the bad news of incompetence in the BCG report and to obscure what they planned for the future.

From the press release associated with the release of the BCG Review of NEHTA we also learned that the Board has been busy. In their words:

“The Board of NEHTA also endorsed a business case for developing a national platform for personal electronic health records to be put to the Council of Australian Governments (COAG) early next year.”

The Australian article makes it pretty clear the information to be held on the Shared EHR will be (to quote):

“ Core elements of most profiles would include:

* Allergies, alerts and adverse reactions.
* Current and ceased medications.
* Problems and diagnosis, active or persistent disorders.
* Family and social history and immunisations.
* Implants such as pacing wires, joint prostheses and medication implants.
* Screening results such as the last date and outcome of Pap smears and mammograms.
* Key physiological measurements, height, weight, body mass index.
* Planned activities, care plans and history of recent and past procedures.”

What does all this mean. It means that NEHTA imagines (fantasises) that it is ready to approach the Council of Australian Government (COAG) with a business case to implement a quite advanced Shared EHR over the next four years!

Implied in all of this is that NEHTA has worked out

1. the details of how the Shared EHR will work.

2. how the planned record will interact and communicate with hospital, specialist and GP systems

3. how the data will be stored and secured

4. how privacy will be protected and

5. how much it will all cost and what the benefits are that will flow from the recommended spend.

Even more amazing is that the business case apparently suggests this can all happen within four years – i.e. by 2012.

If COAG buys this megalomaniacal hubris, and agrees to this, it will be a total disaster and set back E-Health in Australia for a decade in my view.

Why is this initiative doomed to fail (Here is where recent and more distant history comes in)?

First, as we learn from the recent BCG report, NEHTA does not seem to be able to manage even quite simple projects effectively (can’t get staff, can’t spend what is needed and lacks implementation expertise for starters). Doing a project of this scale is clearly way beyond them – even with partners such as IBM and Telstra which you can bet they are hoping will do the heavy lifting.

Second, again as we learn from the BCG report, NEHTA has virtually no capability to engage with the Health Sector and simply does not ‘get health’. A project of the scale contemplated by NEHTA is not doable in that circumstance.

Third, when similar ideas were trialled in the years 2002-2005 by the Commonwealth, under the HealthConnect banner, the pilots were such dismal failures that not a single one was continued with in its planned form and ultimately the whole program turned into a ‘change management strategy’ having wasted $100 million +.

Fourth, to have a Shared EHR it is vital that the data that is shared from operational systems is of high quality and integrity – i.e. is ‘data for sharing’. NEHTA does not even have a plan for GP and Specialist data quality enhancement (it has cost the UK hundreds of millions of pounds over many years to make progress) and so ‘garbage in, garbage out’ will be the order of the day.

Fifth, the UK, Canada and the US have has EHRs on the political agenda for 4-5 years to build public support for a Shared EHR project – we have had one article in the Australian two days ago after a hiatus of years.

Sixth, it seems that we have had a collection of NEHTA boffins who, according to the BCG are not seen by practicing Health IT experts as being of much use, invent this business case in secret away from the public eye as well as those who actually understand the risk and complexity of such undertakings. So much for the new open NEHTA and for any substantial chance of success!

Seventh, any maturity analysis of the Australian status in E-Health would quickly show we are a full 5-7 years away from being able to successfully conduct such an ambitious project – lacking the people, implementation skills and technical infrastructure to make it work.

Eighth, Australia does not have a National E-Health Strategy that positions a proposal of this type sensibly. All elements including the doctors and nurses, support staff, technologies, partners and training need to be co-ordinated and managed. This is a strategic national effort which will take many years – not something to be rushed through COAG on the opportunity of a Government change.

Lastly, from what is known of NEHTA’s benefits work, there are a lot of assumptions based on effective Clinical Decision Support. Systems with these capabilities are still largely aspirational at this point of time in terms of widespread use and it seems likely NEHTA’s benefits case will be little more than wild guesses dressed up with flash graphics. COAG beware!

How should NEHTA actually be proceeding?

First NEHTA should engage with COAG to fund the development of a genuinely inclusive and practically based National E-Health Strategy. This could address many of the present uncertainties about what is practical, what is possible and what might work.

Second it should review, refresh and release all the documentation associated with HealthConnect Version 1.

Third the reality of the costs and benefits case needs to be subjected to hardnosed analysis through proof of concept implementations that can be shown to deliver in the real world. Hand waving assumptions should simply not be accepted.

Fourth NEHTA should release, for public review and discussion, the current business case so we all know what is planned, what will be the outcomes and can bring the Health IT Communities expertise to bear on the entire project to maximise the chance of cultural, technical and financial success. This should lead to a much more robust plan being approved late in 2008 – and having some chance of success when implemented.

Fifth – at the very least – the Shared EHR should be piloted in one State (it needs a pilot of that scale I believe to be credible) and once all the issues are resolved – a move to national implementation can be commenced. Just jumping in with the whole country is clearly crazy.

Shared EHR’s have been very problematic in large countries with success seemingly being confined to the smaller states such as Denmark etc.

Before I conclude I need to say I would really like a Shared EHR to proceed in a planned strategically rational fashion – just not in the unsound and ill considered way proposed by NEHTA which I feel is doomed. I know how hard this will actually be and I fear NEHTA does not have a clue.

If NEHTA goes ahead with its present plans, and COAG is silly enough to approve the request, I am convinced it will be an un-remitting fiasco some 2-3 years out and there will be blame and blood-shed everywhere.

See if I am not right.

David.

Link Between Hospital IT and Patient Safety Becoming Stronger

An interesting paper appeared in the Journal of Healthcare Management recently.

It is reported in iHealthBeat.

Research Builds Case for Hospital IT Adoption To Boost Safety

by Kate Ackerman, iHealthBeat Associate Editor

Despite mounting evidence that IT can help boost patient safety, many hospitals have been reluctant to invest in technology like electronic health records and computerized physician order entry systems.

Only about 11% of hospitals that responded to an American Hospital Association survey released in February reported having a fully implemented EHR system. This reluctance is likely tied to financial, cultural and workflow barriers. In addition, there are several well-publicized instances in which IT actually added to problems at hospitals -- information that clearly supports hospital officials' resistance.

Experts believe that as the volume of research supporting the benefits of health IT increases and as the results of those studies are able to be generalized to hospitals nationwide, health care leaders' resistance to investing in IT will dwindle.

Jon White, director of Health IT at the Agency for Healthcare Research and Quality, said, "There is a good amount [of research] under our belt, but we also have a good amount more to go." He added that as research continues, "providers -- at least those [who] understand the literature and the evidence -- will kind of say you know, 'I deliver better care when I use these tools in this way; therefore, I have kind of a moral responsibility to do that.'"

Mounting Evidence

A study in the current issue of the Journal of Healthcare Management builds on existing research on IT and patient safety at hospitals.

"The evidence that IT when properly implemented can yield positive organizational benefits is beginning to be well known," but most studies on the topic "are conducted in very limited settings -- academic medical centers or other specialized institutions where information generated there may not necessarily translate to the average community hospital," Nir Menachemi, author of the study and associate professor at Florida State University's College of Medicine, said. He added, "So trying to begin filling in more pieces of the puzzle in terms of how IT affects care, we looked at this project so that the information could be generalized to the typical hospital."

The study, called "Hospital Adoption of Information Technologies and Improved Patient Safety," examined the relationship between IT adoption and AHRQ's patient safety indicators at 98 hospitals in Florida. The study found that eight patient safety indicators were related to at least one measure of IT adoption -- a finding the study's authors say hospital leaders should consider when making decisions about IT adoption.

…..

MORE ON THE WEB

• AHA health IT survey
• AHRQ
• "Cedars-Sinai Suspends CPOE Use," iHealthBeat, 1/22/03
• "Study: CPOE System Linked With Increased Patient Mortality," iHealthBeat, 12/8/2005

Read the full article on the web

http://www.ihealthbeat.org/articles/2007/12/12/Research-Builds-Case-for-Hospital-IT-Adoption-To-Boost-Safety.aspx?a=1

Interestingly the full article – without charts – is also available:

Hospital adoption of information technologies and improved patient safety: a study of 98 hospitals in Florida.

by Menachemi, Nir Saunders, Charles Chukmaitov, Askar Matthews, Michael C. Brooks, Robert G.

Journal of Healthcare Management • Nov-Dec, 2007 •

EXECUTIVE SUMMARY

Most of the studies linking the use of information technology (IT) to improved patient safety have been conducted in academic medical centers or have focused on a single institution or IT application. Our study explored the relationship between overall IT adoption and patient safety performance across hospitals in Florida. Primary data on hospital IT adoption were combined with secondary hospital discharge data. Regression analyses were used to examine the relationship between measures of IT adoption and the Patient Safety Indicators (PSIs) of the Agency for Healthcare Research and Quality.

We found that eight PSIs were related to at least one measure of IT adoption. Compared with administrative IT adoption, clinical IT adoption was related to more patient safety outcome measures. Hospitals with the most sophisticated and mature IT infrastructures performed significantly better on the largest number of PSIs. Adoption of IT is associated with desirable performance on many important measures of hospital patient safety. Hospital leaders and other decision makers who are examining IT systems should consider the impact of IT on patient safety.

This really is quite an important article as the iHealthBeat editor makes clear. By showing the relationship between clinical IT infrastructure and improved clinical outcomes the study adds a very significant brick in the wall in the case for further adoption of Clinical Health IT in Hospitals!

Great stuff.

David.

Who Smells the NEHTA Spin?

Well the journalist who heads NEHTA is back to his roots! I wonder how long it took to craft this article? My spies tell me it was weeks! Desperate to manage the obvious outcomes of a deeply negative report card!

To confirm this just look at the carefully crafted collection of ‘alleged’ e-Health progress items.

Healing Australia via broadband

Jennifer Hewett | December 17, 2007

A health revolution is coming that will allow patients, doctors and specialists to use e-medical records, writes Jennifer Hewett.

IMAGINE going to a new medical specialist and not having to take the referral letter, your X-rays and details of your existing medications.

Imagine attending a new GP practice where the GP calls up your previous medical records at the click of a mouse rather than relying on your, er, memory.

Imagine ending up in the emergency room of a public hospital where doctors who have never seen you before can instantly see your entire medical history. Not to mention having your own GP able to immediately see all the comments from the hospital staff, the discharge papers and the recommendations for follow-up treatment. No waiting, no confusion, no falling between the paper cracks.

Yes the personal electronic health record is finally coming to Australia. The concept is relatively simple. It means individual medical details will be easily and always accessible on computer to both doctors and patients, should patients wish.

But while the appeal is obvious so are the complications, not least the privacy concerns.

For the past 2 1/2 years, a group of health and IT professionals has been quietly beavering away to make the idea workable. They staff the National E-Health Transition Authority, a non-profit company whose board includes all the heads of federal and state health departments, with a budget so far of $160 million.

Now comes the next phase.

Following criticism and an independent review that found NEHTA has not consulted widely enough, the company is now trying to work more closely with the medical profession and other potential users of electronic health records.

This week it will announce it has signed a contract with Medicare Australia to design and build the special identification markers for consumers and healthcare providers.

Although it won't be ready for Kevin Rudd's ambitious timetable for a snap meeting of the Council of Australian Governments on Thursday, NEHTA will put its business case to the first COAG meeting next year for the next stage of funding.

Continue reading the very long article here:

http://www.australianit.news.com.au/story/0,24897,22935859-24169,00.html

The plan for a Shared EHR ( it was called HealthConnect then) was knocked back by the Commonwealth Department of Health and Aging in 2005 and has now been resurrected, as a new idea, (which it is not!), to save those involved in the terrible NEHTA inaction and management of E-Health over the last 3 years.

The Shared EHR may be really good idea but it is much more complex and difficult to achieve than is even partially recognised in this transparent ‘puff piece’

What chance, with the surplus in meltdown, as we now hear, this will get funded now?

I am utterly sick of the spin, deception and rubbish we are seeing from this just totally dysfunctional organisation which as late as a week ago was suggesting to its executives that grass roots E-Health initiatives were to be observed and monitored rather than assisted and supported (and this directive was direct from the CEO I am told).

Sorry..we really need a fresh start with a new team! There is no sign anyone can see there will be the level of change and openness we all require.

I have seen some spin in my time – but this article takes the biscuit! That it was planted to try and minimise the impact of the BCG Report should be obvious to the most naive.

David.

The Boston Consulting Group Lets NEHTA off the Hook!

The report of the Boston Consulting Group on their formal review of NEHTA (undertaken August - October 2007) was released this morning:

It can be found at the following URL – along with NEHTA’s response

www.nehta.gov.au/index.php?option=com_docman&task=doc_download&gid=421&Itemid=139.

The report makes six main recommendations which are intended to ensure the delivery of the national E-Health agenda objectives over the next few years:

1. Create a more outwardly-focused culture.

2. Reorient the work plan to deliver tried and tested outputs through practical ‘domains’.

3. Raise the level of proactive engagement through clinical and technical leads.

4. Accelerate resourcing through outsourcing, offshore recruiting and more creative contractual arrangements.

5. Reshape the NEHTA organisation structure to address revised work plan priorities.

6. Add a number of independent directors to the NEHTA Board to be broader advocates of E-Health, and to counter stakeholder perceptions of conflict of interest.

A press release ‘spins’ the NEHTA response to the Review!

----- Begin Release

NEHTA HERALDS E-HEALTH MILESTONES

and announces its action plan for adoption success

17 December 2007

Australia's e-health reform agenda took a forward step today with the release of an action plan by the National E-Health Transition Authority (NEHTA).

The Board of NEHTA also endorsed a business case for developing a national platform for personal electronic health records to be put to the Council of Australian Governments (COAG) early next year.

The NEHTA action plan outlines key areas for ensuring the successful adoption of measures to improve the electronic communication of critical health information.

"After working to build foundations for electronic health since the organisation was established in 2005, we are now in a position to begin to deliver some concrete applications of our work," NEHTA's Chair Dr Tony Sherbon said.

"The new Federal Government has signaled health reform and improvements in state and federal relations as major policy objectives," said Dr Sherbon. "Given also the government's emphasis on

the provision and use of broadband communications, NEHTA is well-positioned to play its role in advancing e-health as part of this new agenda," he said.

"The recent independent review found NEHTA had made significant progress on our goals to date and made a number of recommendations about NEHTA's future. The action plan we are announcing today flows directly from our acceptance of all the recommendations in the review," Dr Sherbon said.

Dr Sherbon identified the action plan as also being an acknowledgement of where NEHTA now needs to go in order to expedite e-health reform in Australia.

"We have come to a point where many of the foundations to enable e-health are in a position where we can now move towards implementation and adoption. Seeking funding to establish a national system of personal electronic health records is also on our immediate horizon. The action plan that we have released will assist this process," he said.

Dr Sherbon said the case for personal electronic health records was compelling. "The safety and quality benefits are manifold. We understand the issues of equity and privacy and firmly believe that

the approach developed by NEHTA will address these to the satisfaction of all our stakeholders and the Australian public."

NEHTA's Action Plan for Adoption Success and the independent review of NEHTA conducted by the Boston Consulting Group are available on the NEHTA website at www.nehta.gov.au.

----- End Release.

Three major things concern me about all this.

My first major issue is that the last paragraph of the executive summary identifying the need for a national Health IT Strategy has simply been ignored by the Board.

"In parallel, planning for the next phase of eHealth coordination and implementation needs to commence now or momentum could be lost. An eHealth strategy and eHealth policies need to be developed. Further analysis and debate by NEHTA and its members on the future vision for eHealth and the role of a central agency (as described above) is needed now to generate a plan by mid 2008. Regardless of the funding scenario and any future role of NEHTA II, we believe that the ‘transition’ NEHTA is tasked to support has at least another five to ten years to run."

I welcome all the recommendations, cited above, as far as they go - but feel they do not point to where the real work is needed - i.e. a National E-Health Strategy.

My second major concern is that while it is clear there have been a very large number of issues with the way NEHTA has operated - there is no apparent accountability for the mis-steps being accepted by the Board and Staff of NEHTA.

That said the BCG report's findings seem to me to accurately reflect the view of external stakeholders (Health IT experts, Health Providers and the IT Experts) but the impact is diluted by continual use throughout the report of the views of the NEHTA staff on the quality of the job they are doing. The staff and Board are hardly likely to be objective regarding their own performance!

My third major concern is that we have NEHTA recommending a Business Case for a National Shared EHR to the Council of Australian Government – and the public has had no apparent input – other than by a discredited NEHTA Board and a few bureaucrats. This is hardly the new open, engaging and consultative NEHTA!

In summary, this report addresses some of the operational, cultural and engagement failures of NEHTA, while failing to firmly recommend the development of a national e-Health plan to achieve value from NEHTA's work. Without this NEHTA will remain an unguided missile operating without strategic context and at risk of continuing to underperform.

To let NEHTA escape without a clear articulation of the need for a National E-Health Plan is really very poor indeed.

I fear the whole BCG exercise has been an expensive piece of ‘window dressing’

David.

BCG Review Report of NEHTA Now Available.

The BCG Review of NEHTA has been published.

It is available here:

http://www.nehta.gov.au/index.php?option=com_docman&task=cat_view&gid=-1&Itemid=139

My comments in due course

David.