NSW Health Sets New Benchmarks for Chaos and Risk.

I have to say the 1100 page Enquiry into Acute Care at NSW Health makes riveting reading.

The report can be browsed in exquisite detail having been downloaded from here:

http://www.lawlink.nsw.gov.au/acsinquiry

While not able to read the whole document as yet I have browsed the sections on IT and Communications from the main report.

There are a good forty pages of reading to be had here –as well as some coverage elsewhere and 250+ citations:

Section 14 -Clinical records & information technology

Importance of clinical records

Patient’s medical history

Observations of the patient

Record of treatment

Requirements for clinical notes

Failings of current clinical notes

Clinical notes presently in use

Lack of searchability

Illegible handwriting

Missing time, date and author details

Inability to check entries

Inability to prompt action

Confusing alterations

Incomplete notes

Limited ability to share records with other health professionals

Lost records

Storage and retrieval burden

Inability to collect data

A defective system

Interstate and overseas experience in health information technology

Training of health professionals

Doctors

Nurses

Allied health

Further training required

Information technology currently in NSW hospitals

Existing examples of electronic medical record in NSW

New electronic medical record being introduced by NSW Health

A variety of systems

Lack of support staff

Onerous password procedures

Inadequate hardware

No off-site access

No access by other health providers

Limited rural access

Clinician’s views

The way forward

Electronic medical record

Electronic prescription systems

Funding of health information technology

Secure Broadband Network

Implementation of electronic medical record

Experience in implementing FirstNet

Lessons to be learned

Privacy concerns

Electronic Health Record

What is concluded is summarised in the Executive Summary and in the following press reports.

NSW Health IT in disarray

Karen Dearne | November 27, 2008

SPECIAL commissioner Peter Garling has prescribed a massive dose of IT to fix NSW's troubled public hospitals, and recommended a watchdog oversee e-health.

He has demanded the provision of critical infrastructure, hospital and community information systems and a statewide e-health record system within four years - not the present eight to 15 year timeframe for completion.

Mr Garling, who has spent 10 months inquiring into the state's acute care services, said he has "accepted the overwhelming evidence" new models of clinical care "can only be achieved if NSW Health adopts a whole new approach to IT".

He has proposed a future IT program including essential upgrades and new systems that will cost more than $705 million, on top of the $315.5 million currently committed to projects scheduled until July 2011.

"The risks to safety and quality of patient care occasioned by delays in the introduction of an up-to-date IT system throughout NSW Health cannot be over-emphasised," Mr Garling said. "It is not until the implementation of key projects that NSW will actually have an electronic medical record for all patients that is integrated across the system.

"In my view, insufficient funds are allocated to IT to get it up to the standard needed in an acceptable timeframe."

To achieve his goals, Mr Garling has called for an independent Bureau of Health Information -- separate from NSW Health -- to be established to access, interpret and report on all data relating to safety and quality of patient care; this information is then to be regularly re-issued to individual units.

More here

http://www.australianit.news.com.au/story/0,24897,24716363-15306,00.html

and here:

Sick NSW Health IT prescribed $700m

NSW special commissioner Peter Garling has prescribed an aggressive 4 million investment strategy to cure NSW Health’s sick information technology systems, in a landmark review published late yesterday.

“Whilst much of the work undertaken in NSW public hospitals is “high tech”, its record-keeping system is a relic of the pre-computer age. - Peter Garling S.C.

“What currently exists is a largely paper-based system with significant variation from clinician to clinician, ward to ward and hospital to hospital,” Garling said in his comprehensive three-volume report on NSW’s health system released yesterday.

“Whilst much of the work undertaken in NSW public hospitals is “high tech”, its record-keeping system is a relic of the pre-computer age,” he said. NSW Health’s IT operations are in general led by departmental chief information officer Mike Rillstone, although each area health service also has its own CIO.

The commissioner has recommended a “one-off injection” of 4 million to remedy a system that had been bogged down not just by paper, inconsistent documentation and illegible handwriting, but also substandard hardware, incompatible software and inadequate broadband connectivity.

“In my view, insufficient funds are allocated to information technology to get it up to the standard needed in an acceptable timeframe,” Garling said.

A lot more detail here:

http://www.dileys.com/2008/11/sick-nsw-health-it-prescribed-700m.html

Before making a few comments I must say I was amazed to note that the ever secretive HealtheLink project is due to be fully rolled out in 2016. That has to be sufficiently far off to have everyone involved to very relaxed about meeting the deadline.

What strikes me about this report is how much better it could have been had a real e-Health expert been involved. The document is really terribly context free. A special clinical advisor could also have made a vast difference.

The suggested extra spend of $700 M seems reasonable – but I doubt – with the best will in the world – and even with stunningly great project management – it can all be done in 4 years.

What seems also to be missing is a process reengineering imperative to maximise the value from the IT spend.

This could have been a much more useful enquiry – but it sure lets one be clear where the issues are!

David.

NEHTA’s Amazing Silence on its New Funding.

OK this really has me surprised!

I went to the NEHTA web site today (2^nd December, 2008 – 3.35pm) expecting to read some detailed comments and news on how NEHTA was going to deploy their new funding.

Checked the news release section and the rolling news items. Not a word!

Who else finds this a trifle odd?

I hope we see a press release soon that explains how the (our) money is to be spent!

No press release is very odd for NEHTA in my experience.

David.

On another topic it is worth noting the commentary in Crikey.com.au from John Menadu on Health Reform today.

The article is entitled:

Menadue: COAG’s billions are a wasted opportunity for health

See here to read the article:

http://www.crikey.com.au/Politics/20081202-Why-COAGs-billions-are-a-wasted-opportunity-for-health.html

This bit really attracted my attention.

The introduction of e-health has been glacial despite the potential benefits in patient satisfaction, reduced costs and fewer mistakes with modern information technology This is not a political or philosophical issue. It is an operational and administrative matter for which government officials must bear the chief responsibility.

D.

Australian E-Health – Where to from Now?

I think it is fair to say it has been a bad weekend.

As reported over the weekend we have had the following statement from the Council of Australian Governments (COAG) on e-Health.

“E-Health

COAG noted the progress of the National E-Health Transition Authority and agreed to the continued funding of $218 million (50:50 cost shared between the Commonwealth and the States) for the period July 2009 - June 2012 to enable it to continue its existing work program.”

The Commonwealth contribution is as follows.

E-health (NEHTA)

2009/10 - $28.7M

2010/11 - $39.2M

2011/12 - $41.0M

Total $108.9M

This is ½ of the total as the rest will come from each of the states.

As pointed out by a correspondent this is really very rapid growth from the 2007/08 financial years sum of $38.715M to approximately $82M in 2011/12.

The real increase in activity could actually be a little more than the figures indicate given all the consultants that can be replaced with more permanent staff now funding is clear for the next 3.5+ years.

If this is to be all the new money for e-Health ($30-40M extra per year over current spend at Commonwealth level and almost certainly flat to negative spend in the States (Mr Garling SC recommendations for NSW Health IT notwithstanding) then progress, if any, will be dreadfully slow!

What this funding of NEHTA for the next few years has done has ensured that its leaders feel vindicated in the way they have behaved – they have essentially been ‘patted on the head’ – and any real stimulus for ‘root and branch’ change has been lost.

There is also a bit of a problem in that without a co-ordinated national direction it is a little murky as to who will be able to get the full value out of the planned NEHTA spend.

More importantly what has been lost is the opportunity to put in place the sort of national strategy and national governance of e-Health. This will lead, almost inevitably, to waste and inefficiency in how the new money is spent. Of course that waste and inefficiency will be dwarfed by what will flow from failing to properly automate the health sector.

It is clear that without judicious, planned – but quite large – investment in Health IT that our health system is drifting towards the un-sustainable. Not getting going now in a serious and co-ordinated way will come back to cost us all dearly in the future. (much like not addressing Climate Change early means you pay a lot more to fix things up later).

With this expensive and large outcomes of this COAG meeting it is virtually certain that Commonwealth Investment in Health is going to exceed 10% of GDP, if not get close to 11%, especially as our economy contracts because of the “Global Financial Crisis”. Health IT can slow this growth – but only if you invest in it!

What has also been lost is an opportunity to commence planned co-ordinated investment in Health IT in a way that is designed to maximise benefit to all the actors within the health system.

Whoever decided not to fund and implement the Deloittes developed National E-Health Strategy for Australia – after so many stakeholders agreed we need such action – is to be utterly condemned.

Ultimately it is the Federal Minister who must take responsibility for this decision and she should be asking very hard questions to assure herself she has not made a major mistake which will cost a great deal to remedy both politically and financially.

Remember not only has the National E-Health Strategy been canned but also has the IEHR, which was the reason NEHTA was said to be mainly developing their infrastructure. Talk about ‘being all dressed up with nowhere to go’!

We now have a situation where there is confusion between the Deloittes Strategy and the NEHTA IEHR proposal. The Deloittes approach is correct – but because the waters have been muddied -neither have gone forward. That is a huge mistake in my view.

The only, and last, hope left is that the Australian Health Ministers Advisory Council Meeting (AHMAC), which meets at the end of the week (I am told), unlocks funds from the National Health Infrastructure Fund to get things going properly. I understand this fund is separate from the COAG funding.

As far as the future is concerned, if that last hope does not come off, I see only fragmentation and waste with worsening levels of quality and safety within our system. Sad that.

David.

Blog User Interest in COAG Fiasco.

I thought it would be worth letting readers know the impact on the blog use of the breaking news on the outcomes of the Saturday COAG meeting has been just amazing.

On the weekend typically we have only about a quarter to a third of the weekday visits (about 30-40 per day)

On Saturday there were 101 Visits (187 Page Views) and on Sunday 175 Visits (275 page Views).

These were the biggest Saturday and Sunday figures by at least 150%.

Today we are already at almost 100 Visits before 11am with 200+ Page Views already.

There are also a lot of pretty frustrated comments that are worth a browse.

Seems a nerve has been hit!

Thanks to all.

David.

Useful and Interesting Health IT Links from the Last Week – 30/11/2008

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

These include first:

Medicare worker 'used dead people to claim baby bonus for 58 fake kids'

AAP

November 27, 2008 07:39am

A MEDICARE employee has been charged with using the identities of dead people to claim more than $300,000 in false baby bonus and immunisation payments for 58 fictitious children.

Australian Federal Police allege the man used his position as a Medicare Australia employee to access the Centrelink records of dead people to obtain encrypted tax file numbers (TFNs).

An AFP statement said the Perth man allegedly used the TFNs to create 23 false claims for baby bonus and immunisation payments for 58 fictitious children, which were then paid into his bank account.

He allegedly claimed more than $300,000 in false baby bonus payments.

More here:

http://www.news.com.au/story/0,27574,24714164-29277,00.html

While this person is probably a crook if the reports are true, the larger issue is how the systems (Medicare and Centrelink) could not notice such systematic and expensive abuse for such a long period. We would hope e-Health systems were a bit more proactive in detecting fraud earlier. Additionally these are two major systems with linkages that permitted abuse and these need to be carefully reviewed and secured.

Looks like Medical Identity Fraud is a real issue in OZ - as discussed a week or so ago.

Second we have:

Revealed: how hospitals lied about records

Natasha Wallace and Louise Hall

November 27, 2008

SECRET internal health documents have confirmed two hospitals manipulated emergency data, making the times that more than 100 patients were seen appear "more favourable" to meet benchmarks.

The confidential internal investigations into Ryde and Gosford hospitals' emergency data were obtained by the Herald under freedom-of-information laws yesterday.

Both investigations recommended staff, some of who admitted to entering false data, be disciplined and the reports be sent to ICAC. Both reports said senior management had ignored staff complaints about the issue.

The December 2006 report on Ryde Hospital concluded that in late 2005 staff changed figures and sent false data to the Health Department - in effect, doubling the percentage of patients transferred to a bed within eight hours.

"This investigation identified that during the months of November and December 2005 a significant number of changes were made to the [emergency] data which consequently presented a more favourable access block statistic for Ryde Hospital for these months … this practice started in September 2005 and there is evidence to support that the practice continued up to and throughout February 2006," the report said.

It said "it appears that there was an executive decision made to make changes to [emergency department] data".

Staff told investigators management was under pressure from the area health service to improve the hospital's triage performance and that staff had formally complained of being "coerced" to change the data.

"Initially we probably weren't too happy with it but decided that given our effective manager at the time was being beaten by the area for access block [patients waiting more than eight hours]," one staff member said.

Despite several staff complaints between October 2005 and March 2006, "the practice continued unhindered until it was raised to an area level".

The report said the issue "could be occurring across the state and is one which the Department of Health should give consideration to reviewing".

In November and December 2005, 99 patients had their waiting times reduced to meet benchmarks. The waiting times were reduced by between 23 minutes and four hours and 25 minutes so the hospital could improve its "access block" rate - the percentage of patients waiting more than eight hours for a bed.

The manipulated data meant Ryde Hospital reported figures significantly below previously reported data - access block figures were reported as 19.8 per cent for the October-December 2005 quarter compared with rates as high as 43.9 per cent previously. For December 2005 it was reported as 13 per cent when it should have been 28.3 per cent.

More here:

http://www.smh.com.au/news/national/revealed-how-hospitals-lied-about-records/2008/11/26/1227491636518.html

This is really a bad story and makes one worry about the reliability of all figures produced by NSW Health. The culture in NSW Health that forces people to behave like this in fabricating data is clearly appalling.

Third we have:

Medical searches on Web can trigger anxiety: study

November 26, 2008 - 3:57AM

Playing doctor on the Web often leads people to mistakenly believe that they are suffering from rare illnesses, according to a study by researchers at Microsoft.

"Web search engines have the potential to escalate medical concerns," or "cyberchondria," Ryen White and Eric Horvitz wrote in the study published by the Redmond, Washington-based software company on Monday.

They described cyberchondria as "unfounded increases in health anxiety based on the review of Web content."

White, an expert in text mining, Web search and navigation, and Horvitz, another Microsoft researcher who is president of the Association for the Advancement of Artificial Intelligence, noted that the Internet provides an "abundant source" of medical information.

"However, the Web has the potential to increase the anxieties of people who have little or no medical training, especially when Web search is employed as a diagnostic procedure," they said.

"Common, likely innocuous symptoms can escalate into the review of content on serious, rare conditions that are linked to the common symptoms," they said.

Much more here:

http://news.smh.com.au/technology/medical-searches-on-web-can-trigger-anxiety-study-20081126-6hm1.html

Another new word to add to the vocabulary. I am sure it is just another manifestation of the old saying “a little knowledge is a dangerous thing” and also potentially worrying.

Fourth we have:

Commonwealth Bank fixes computer glitch

November 26, 2008 - 7:10AM

The Commonwealth Bank has fixed up the problem that short-changed around 200,000 people due to a computer glitch.

Process duplication meant that all withdrawals on Tuesday had been done twice, leaving people with less money in their accounts.

But the bank said on Wednesday that the problem had now been fixed and all its customers' accounts were back in order.

More here:

http://news.smh.com.au/national/commonwealth-bank-fixes-computer-glitch-20081126-6hnj.html

This reminds me of the old saying that to ‘err is human but if you really want to mess up use a computer’. This one actually got me and for a while I thought I had more money that I actually had!

Fifth we have:

Internet's bandwidth health still in trouble, report says

Demand for Internet bandwidth will exceed supply by 2012, Nemertes says

Brad Reed (Network World) 24/11/2008 07:08:00

Nemertes Research continued to throw cold water on the future of the Internet this week, releasing a study projecting that demand for bandwidth on the Web would exceed its capacity by 2012.

The study, which is a follow-up to similar research Nemertes conducted last year, projects that the current global economic recession will only delay rather than eliminate the increased demand for bandwidth the firm predicted last year. Then, Nemertes projected that traffic growth would eclipse supply by 2010, but the firm now says it has adjusted its projections to reflect deteriorating global economic conditions.

Nemertes emphasized it is not projecting that the Internet will crash or shut down altogether. Rather, the typical user probably will experience Internet "brownouts," where such high-bandwidth applications as high-definition video-streaming and peer-to-peer file-sharing will stop performing up to users' expectations, the firm says.

During a presentation at an Internet Innovation Alliance symposium last week, Nemertes analyst Mike Jude said that one consequence of declining Web performance would be that users would look less to the Internet to deliver their desired applications. "More and more applications are coming online that will drive expectations for service quality even higher," he said. "I'm not saying that the Internet is going to crash in 2011, but that people's expectations are going to be throttled. People will stop going to the Internet for those services."

More here:

http://www.computerworld.com.au/article/268462/internet_bandwidth_health_still_trouble_report_says?eid=-255

It is a bit of a worry we only have Internet bandwidth globally to support the next couple of years. I hope someone does some investment soon to keep us ahead of the curve.

Last we have the slightly more technical article for the week:

Conroy defends Telstra's NBN bid

Panel to fight hard-nosed commercial negotiators.

Darren Pauli 28/11/2008 13:40:00

The federal government has defended its acceptance of Telstra's "non-compliant" National Broadband (NBN) proposal and said its expert panel will thrash out the details with the telco.

Telstra outraged many within the telecommunications industry this week after submitting a watery 12 page bid to address the government's strict 18-point criteria for the design and operation of Australia's largest telecommunications network.

Telstra would deploy fibre to the node to 90 percent of Australia, 8 percent short of the government's coverage requirements which it had staunchly enforced.

Communications Minister Stephen Conroy said the compliance of Telstra's bid will be assessed during the initial expert panel negotiations over the next eight weeks.

“Telstra have indicated that they believe that it's a proposal that can be considered... and the expert panel will now test it against the 18 objectives,” Conroy said.

“[Telstra is] absolutely not [calling the shots], let's be clear. Telstra have been demanding concessions, as have others... we're not going to be pushed around on this, we're not going to deviate from what we've set down,” he said.

“Is it any surprise that any of the bidders might say, give us more government money, and we might be able to reach your objectives? These are hard-nosed, commercial negotiators, and this will be a tough, hard-nosed negotiation between the expert panel, and there's some very tough, hard-nosed commercial people on the expert panel.”

The government received six NBN bids, including national proposals from Telstra, Terria-Optus, Acacia and Axia NetMedia, and state bids from TransACT, and the Tasmanian government. Canadian-based company Axia NetMedia has an equal stake in Singapore's national fibre network which is owned by Optus parent company SingTel.

The members on the expert panel are John Wylie, Lazard Carnegie Wylie CEO; Tony Mitchell, Allphones Chairman; Laureate Professor Rod Tucker, University of Melbourne; Professor Emeritus of Communications, Reg Coutts, University of Adelaide; Tony Shaw, former Australian Communications Authority Chairman and Dr Ken Henry, Treasury Secretary.

More here:

http://www.computerworld.com.au/article/269125/conroy_defends_telstra_nbn_bid?fp=&fpid=&pf=1

What can one say about the mess Minister Conroy has created here. The way you procure goods or services, as a Government, is to decide exactly what it is you want to buy, specify it, and then go to the market to procure what it is you want. None of this has been done properly and the broadband e-Health needs is now even further off. Hopeless!

More next week.

David.

E-Health Update from COAG

Official word on the COAG outcome came out a few minutes ago (8pm 29/11/2008).

See:

http://coag.gov.au/coag_meeting_outcomes/2008-11-29/index.cfm

"E-Health

COAG noted the progress of the National E-Health Transition Authority and agreed to the continued funding of $218 million (50:50 cost shared between the Commonwealth and the States) for the period July 2009 - June 2012 to enable it to continue its existing work program."

So $75 Million a year for 3 years to just keep NEHTA funded. Just hopeless and pathetic. These decision making ministers are just beyond help.

Note: The actual funding document says as follows

E-health (NEHTA)

2009/10 - $28.7M

2010/11 - $39.2M

2011/12 - $41.0M

Total $108.9M

Not a strategic dollar to be seen anywhere.

What this decision does is reward a deeply dysfunctional and un-reformed NEHTA while failing to acknowledge the desperate need for major change in e-Health governance, applications, education and service delivery.

NEHTA was reviewed a year or so ago, told to improve drastically, really has not and now is given three more funded years to mess things up even more!

Previous post says it all! This is the worst possible outcome I could have imagined and I find it very sad for the health system in Australia - that will labor without the technology support it so desperately needs.

A pox on all their houses in my view.

David.

The Clueless Roxon Lets the Australian Health System Remain in the Dangerous Era of Pen and Ink.

It is now quite simple. If the outcome of COAG is as reported – and e-Health has been deferred / cancelled - then the present Federal Health Minister literally has ‘blood on her hands’

The news is as follows.

Colin Barnett says health funding priority for Kevin Rudd

Article from: AAP

November 28, 2008 04:54pm

THE Rudd government's contribution towards health funding is the top priority at a meeting of the nation's leaders, WA Premier Colin Barnett says.

Premiers and chief ministers meet Prime Minister Kevin Rudd and Treasurer Wayne Swan at the Council of Australian Government on Saturday.

An $11 billion plus package for hospitals, education and housing was presented to state and territory treasurers on Friday.

Two thirds of the $11 billion is expected to go towards health.

.....

``Two areas of disappointment - it appears that the national partnership program on improving cancer treatment and e-health it looks like that's been pushed into future years or let go,'' Mr Barnett said.

E-health, which would transfer papers and records from GPs to hospitals to electronic form could increase the efficiency of the health system, Mr Barnett said.

Full article here:

http://www.news.com.au/perthnow/story/0,27574,24721357-2761,00.html

Multiple other reports carry the same comments.

The bottom line is this.

Medical Errors Kill People.

E-Health can prevent some of these. You don’t start implementation and you have to accept the fact your inaction in this area is actually killing people, over time.

Pretty easy to follow.

To get started and make the system systemically a lot safer might have taken a quarter of the planned budget on clinical training and the money would have been well spent.

Just how dare they not provide some small start up funds to start work on implementation of the Deloittes National E-Health Strategy after all the time, effort and money that has been wasted to date! That at least would have been a helpful signal for maybe further funding from the Health Infrastructure Fund early next year.

It seems all the changes at NEHTA have made no difference to the COAG outcome. Those involved should now surely re-consider the place in the e-Health scheme of things..as they have clearly failed in the task they had to persuade Government to invest in e-Health.

Ms Roxon, you are a minister and you then have to accept the consequences of both your actions and inactions. Pity you don’t understand health and the health system.

You have failed on this one!

Before too many die, can I suggest you reconsider.

David.

PS . Nothing personal against the Minister! – this is just a total policy stuff up from the bureaucrats.

D.

PPS. Sorry, and apologies, to all if zillions have been committed and Mr Barnett got it wrong!

D.

Australian E-Health At A Major Fork in the Road – I Wonder Will COAG Get it Right?

This is probably the most important blog entry I will ever write – as what is decided at the Council of Australian Government (COAG) Meeting on Saturday will decide if we will ever see the full value that e-Health can offer delivered to the Australian public and, incidentally if I will bother writing this blog anymore.

Can I say the reporting over the last few days gives me great concern that there is about to be an awful mistake made.

From yesterdays Australian Financial Review we have the following:

COAG set to give e-health shot in the arm

Wednesday, 26 November 2008 | Ben Woodhead

State and federal government leaders are slated to assess plans for the national introduction of potentially life-saving electronic health records when the Council of Australian Governments meets in Canberra this weekend.

Proponents of the business case -finalised by the National E-Health Transition Authority (NEHTA) in September-are waiting for COAG members to sign off on the plan, which would help implement an individual electronic health record (IEHR) for every Australian resident.

IEHRs are expected to cut the rate of medical error and improve efficiency in the health system by making patient information such as medications and allergies available online to authorised clinicians.

Supporters of the technology had hoped the business case would receive approval at October's COAG meeting, but the discussion slipped off the agenda in the face of the spreading global financial crisis

It is understood the business case is on the agenda for this weekend's meeting. But sources cautioned the number of issues up for discussion meant the planned review could again be bumped.

Nevertheless, a spokeswoman for NEHTA said the organisation was hopeful state and federal leaders would consider the business case.

More here:

http://www.misaustralia.com/viewer.aspx?EDP://20081126000030577113&section=news&xmlSource=/news/feed.xml&title=COAG+set+to+give+e-health+shot+in+the+arm

What concerns me it the focus on the mythical and poorly defined IEHR and the desire of some (undefined and clearly non-expert individuals) to develop and implement such a system – with the associated reduction on the emphasis on solving the real problems we have at present.

COAG and the Government have had the final version of the Deloittes National E-Health Strategy for month or two. This document is a pragmatic, well thought out, deliberately incremental approach to the development of e-Health in Australia.

It suggests we invest in getting basic infrastructure, secure communications and terminology right (as NEHTA is trying to do at present) while we commence work with both private and public sectors to implement, develop and certify the appropriate applications for each of the sectors of the Health System (Hospitals, GPs and Specialists, Pharmacists, Allied Health and so on). It is at the local ward and clinical desktop where the majority of benefits in terms of quality and safety can be achieved!

The release of the Garling Enquiry today (27 November, 2008) makes the point forcefully regarding the need for operational systems, with him commenting over pages on the inadequate capacity and utility of the information systems in use in NSW Public Hospitals and the negative impact this is having. Mr Garling does not want a slow pace of progress either – he wants full implementation of all relevant applications completed in all hospitals within 4 years. (See pp50-51 of the Executive Summary and Recommendations document)

See:

http://www.lawlink.nsw.gov.au/acsinquiry

There could hardly be more compelling evidence that we need to get the local information technology properly deployed and utilised before we embark on mega and privacy conflicted shared electronic records. Walking before running has always been a sensible approach.

It also suggests we focus on messaging so we can share the information contained in referrals, results, discharge summaries, specialist letters etc and so we can also develop a national e-prescribing environment that goes beyond ‘prescription printing’.

Once this is all working it is then suggested we move progressively to formal health information networking (starting locally and gradually scaling in size) and eventually, maybe, develop shared repositories of crucial clinical information for access where needed and when the public is fully comfortable with the risk benefit profile of such initiatives.

NEHTA on the other hand – desperate to survive after its present funds run out in June 2009 – is pushing that it be allowed to continue its present work – a good idea if better managed – and to undertake this huge national IEHR project – where all the evidence from around the world is that such huge projects inevitably fail unless led and instigated by clinicians (and the public) not technologists – of which NEHTA and Government has very few!

Deloittes also fully addresses the issues of governance of e-Health and ensuring we have appropriate balanced Health Sector input into e-Health with the clinical driving the technical and not the other way around as it has been to date.

If what comes out of COAG is the funds to implement the Deloittes approach over the next few years I will be a happy person. If we see approval for the nebulous IEHR and NEHTA retaining a lead role (with its cultural problems and technological focus) I am out of here and will find something that has a higher chance of success to focus on.

It is my view that this is a significant test of the competence of the Federal Government and Health Minister that the flawed vague and poorly thought HealthConnect Mark II (IEHR) is seen for what it is – a very bad idea.

Of course the option of no new investment in these difficult times also exists. If this happens we will know for sure we have a totally clueless, or worse impotent, administration of the Health Sector.

We will know next week I guess just where we are and whether hope and common sense can prevail.

David.