Looks Like Any Major e-Health Investment in Australia is Off the Table.

The following great summary of the e-Health Section of Senate Estimates Hearings from last week appeared this morning. What we learn certainly requires being highlighted!

NEHTA on target, says Health secretary

Karen Dearne | October 26, 2009

THE nation's top health bureaucrat Jane Halton has ruled out major investment from government in e-health systems "to have everything happen instantly".

Pressure has been growing within the e-health community as a growing pile of reports warn of the cost of inaction, following the Council of Australian Government’s acceptance of a National E-Health Strategy last December.

The strategy put the cost of establishing a nationwide electronic health record system at around $1.6 billion over four years.

Queensland Liberal Senator Sue Boyce was seeking information on progress of various National e-Health Transition Authority outcomes previously promised for delivery by December this year, including specifications for secure messaging, clinical terminologies, electronic referrals and e-prescribing.

Earlier this month, NEHTA released its own strategic plan, positioning itself as an implementation agency as adoption of e-health accelerates.

"The e-health community is feeling a little irritated by what they see as a lack of progress in this area," Senator Boyce said. "The view has been put to me that NEHTA was established in 2004 and their budget has been more than $200 million."

Responding to questions at an estimates hearing this week, the federal Health Department secretary said the bottom line was that "we are trying to build a national system that will enable private investment and private engagement".

Ms Halton said all of the work on NEHTA's delivery schedule was on target "and is as good as you will get around the globe. Genuinely I think that. Okay, they might want several billion dollars more. That is fine as an ambition. But in terms of taking relevant, logical, ordered steps towards this e-world, I think actually we are not doing too badly".

Ms Halton said NEHTA's job was to ensure that there were not six or eight railway gauges in this country in respect of e-health.

"None of us wants a world where what we have stored in terms of our medical records is controlled by a proprietary product in a doctor's surgery or something else," she said. "We want interoperability and the ability to say, 'Are you Senator Boyce?' such that no-one can steal your identity or misconnect a record about you.

"This is not just about security, and security is absolutely fundamental. It is also about ensuring that there are not islands of information over here that somebody owns and islands over here that somebody owns, and any notion of basically connecting those two up - which would be in your interests medically - is either controlled and charged for privately by somebody or is just not able to happen."

Lots more here:

http://www.australianit.news.com.au/story/0,24897,26259868-15306,00.html

This is a must read summary. For the full transcript of the hearing my earlier post provides a direct link.

See here:

http://aushealthit.blogspot.com/2009/10/spin-alert.html

All one can now think is that we have the situation where NEHTA is building one of those ‘highways to nowhere’ so beloved of the US and Japanese porkbarrelers.

Looks like the target NEHTA was aiming for has just been taken down and carted away!

If there is no plan to invest in the systems that will use what NEHTA is building in the relatively near-term future then why bother? There is a real risk it will all be an outdated white elephant by the time anyone get round to adoption at this rate!

It is good Ms Halton thinks we are doing ‘not too badly’. She is actually ‘not doing too badly’ at doing essentially nothing and attempting to pass it off as activity.

We are hardly likely to see much investment from the private sector with this being what Government is planning, so I think her strategy to attract funds is doomed from the start!

Just hopeless!

David.

Postscript:

There is more commentary that I have just found here:

NEHTA unsure of own success

By Suzanne Tindal, ZDNet.com.au

26 October 2009 12:34 PM

The National E-health Transition Authority (NEHTA) was unable to measure how many organisations were using the products it was creating, according to a secretary for the Department of Health and Aging.

Much, much more here:

http://www.zdnet.com.au/news/software/soa/NEHTA-unsure-of-own-success/0,130061733,339299215,00.htm?omnRef=1337

I find what Ms Halton said here just plainly offensive. To quote:

“When Boyce raised community concerns that e-health was not progressing, Halton said that people needed to "calm down a bit about this".”

She clearly does not care about the lives e-Health, when implemented, can save.

D.

Apparent Australian Censorship of Adverse Academic Commentary on EHR Provider and NSW Health.

The following appeared a little while ago in the US.

Academic Freedom Curtailed: Censorship Down Under On EHR's for the Emergency Department?

In a stunning development:

The essay on Emergency Department electronic health record (EHR) problems in the Australian state of New South Wales (NSW) by medical informatics professor Dr. Jon Patrick, Health Information Technologies Research Laboratory (HITRL), University of Sydney, that I referenced in my posts "The Story of the Deployment of an ED Clinical Information System ‐ Systemic Failure or Bad Luck" and "NSW Nightmare and Overuse of Computers" has been censored. This apparently occurred at the level of the Ministry of Health.

The essay was available as item 6 at http://www.it.usyd.edu.au/~hitru/index.php?option=com_content&task=view&id=91&Itemid=146 . Attempts to download now provide a message "This document is not currently available." I do not know if the vendor was involved.

(A copy of vers. 3 of Professor Patrick's report is still available here in PDF; it was a work in progress when it was pulled.)

Complete blog here:

http://hcrenewal.blogspot.com/2009/10/academic-freedom-curtailed-down-under.html

I can’t say I disagree with the poster (Thanks Scot for letting me know about the post)!

It would be nice to have honest academic criticism to be able to be freely discussed and reviewed. Indeed such a freedom is vital in any decent democracy – but this is happening in NSW! Enough said.

David.

Postscript:

As of 10am Sunday 25 Oct Professor Patrick has said he is happy with the way Sydney University is handling a complaint they have received. He also says 'time will tell' if that continues to be the case.

D.

Postscript 2:

File is no longer available from the US - as Prof Patrick has asked it be taken off-line for now.

D.

Spin Alert!

The Senate Estimates Transcript with DoHA and NEHTA being questioned about their progress is now available here:

http://www.aph.gov.au/hansard/senate/commttee/S12497.pdf

A good read from about page 102 on!

Lots of things being taken on notice as DoHA seems to be an answer free zone.

Main impression is that the answers just muddy any understanding of what is planned in the EHR/EMR/IEHR/SEHR/PHR domain. We really need a clear statement of just what is planned.

See the Australian IT News Page for more details.

http://www.australianit.news.com.au/

Enjoy!

David.

Believe It If You Want – But This is a Really Bad Plan!

The following is part of the lead item in the www.chik.com.au newsletter (Free version)

Health ICT Headlines - 21/2009

Amid the flurry of Australian e-health activity reported in this edition, an observer could believe that Australia's e-health record strategy is adrift and close to foundering on dangerous shores. CHIK does not believe that this is the case. In particular, there has been concern in relation to an apparent renewed government focus on commercially developed, person controlled e-health records as a ‘quick fix' to Australia's e-health needs. CHIK agrees with Peter Fleming, CEO of the National E-Health Transition Authority, that it is likely that several e-health records will be available in the market. That scenario makes NEHTA's role in ensuring standards, privacy rules plus infrastructure (including indexing) all the more critical.

--- End Extract

This observer thinks the bolded sentence is true (i.e. we are drifting in a hopeless strategic vacuum) and that what will happen, if the this multi-vendor commercial outcome, as is apparently being supported by Peter Fleming and NEHTA, actually occurs it will be very sub-optimal. I believe that this commercial strategy is very poorly conceived and will fail to provide the benefits we all hope for from a quality implementation of appropriate e-Health.

I also believe CHIK is quite wrong in supporting this, but that’s up to them!

That’s my 5 minutes of blogging for the day. Back to Handel.

David.

I Am Really Trying to Give This Up!

Posted to encourage some professionals to respond.

Should every Australian have their own, portable e-health record?

5:02pm, 20 Oct 2009 by Ross - yourHealth Team

The idea of having personal electronic health records, controlled by each individual, has been recommended by the National Health and Hospitals Reform Commission.

In its report A Healthier Future for All Australians , the Commission said, “Much like the state and private railways of the 19th century, Australia runs the risk of un-linked electronic health infrastructure.

“From remote communities to metropolitan hospitals, governments, private companies and clinicians have implemented dozens of innovative e-health projects.

“But much more can be gained by taking advantage of synergies and committing to a truly national effort to optimise the system.”

Each individual’s e-health record would be designed to give them better access to and more control over their own health information.

With an individual’s approval, health care providers and carers could instantly access the same, up-to-date patient information - avoiding asking them the same questions and manually re-entering patient data.

The Commission believes this approach would help reduce waste and inefficiency in the creation and use of health information and lead to better, safer care and improved health outcomes.

.....

What do you think?

More here:

http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/content/blogtopic?Opendocument&blogid=BLOG00008

My view is that they are asking the wrong question and that there is a Government agreed strategy about what is needed that they should be implementing!

Go for it - comments I mean!.

David.

Form Your Own View on This!

This link to a blog post is passed on without major comment.

http://www.openforum.com.au/content/australia-finally-heading-right-direction-e-health

The associated report (link in the post) makes interesting reading.

I am not sure lawyers are the ideal people to form e-Health policy.

Back in my box!

David.

I Guess This is a Good Time to Stop All This, and Say Goodbye and Good Luck!

Well, as they say, the time to leave is on a high.

That is where the blog is and that is why I am stopping it.

The statistics from yesterday tell the story.

Australian Health Information Technology

VISITS Total 113,744

Average Per Day 206

Average Visit Length 3:15

Last Hour 6

Today 90

This Week 1,442

PAGE VIEWS Total 187,474

Average Per Day 375

Average Per Visit 1.8

Last Hour 7

Today 170

This Week 2,626

From here we also see:

FeedBurner Reader Count

1165 readers:

Pretty cool! I never imagined Health IT was so interesting.

The blog has been online since March 2006 and it seems to me 3.5 years is long enough to cause me stop giving myself a headache by repeated banging of my head on a hard object!

It seems to me the failure of the Australian National Government to have to capacity to get its act sufficiently together to even enunciate a policy for the deployment of Health Information Technology in Australia is a total failure of governance and leadership. The case for action is totally clear, they (the Government) are just incompetent and worse, they are killing patients through inaction.

NEHTA is an absurd money-wasting joke, the reasonable and the not too expensive National E-Health Strategy (which pays for itself in the medium term and which would make a major difference) has been ignored and instead we see wacky ideas from the likes of Peter Fleming about how important a commercial focus is, and what a wonderful thing it would be to have Google and Microsoft help. (Even thought Google at least wants no part of it at present)

The investment in NEHTA now well exceeds $200M and nothing has been returned that anyone can see.

After 1000 posts it is time for some-one else to carry this forward and for me to get on with listening to music (Handel especially) and spending time working out how to spend the rest of my life disengaged from the incompetent and the stupid who, for unfathomable reasons, seem to be determined to have nothing good happen.

To those who have read and commented – thanks heaps! There has been wisdom and honesty found here which is certainly not found in the public domain.

To those who have something to say. Send me your text and if it is reasonable I will publish it under your name on the blog. Otherwise this is all over and the ‘forces of darkness’ can celebrate as they slip into the inevitable abyss.

To those who enjoyed what I have written, it was a pleasure. To those who were made to feel I was less than impressed with them – well tough – you earned it!

I will leave the blog up as a searchable resource for those who want reference etc.

I have the comfort of having tried, and failed, rather than never having tried. I am content if a little disappointed.

A friend, probably wisely, pointed out that the Government and NEHTA have got what they want. Minimal cost, minimal public upset and a story to tell about how they are trying if anyone asks. A Machiavellian trifecta if ever there was one.

Once I post this I will have my life back. Live long and prosper!

David.

ps. There just might be a post every few weeks just to highlight some especially pathetic bit of nonsense. I may not be able to help myself .

D.

The NEHTA Spin Cycle Tangles Itself Up!

The following note appeared on the 6minutes.com.au web site a few days ago.

NEHTA misquoted

Person-controlled records (link)

The 6minutes adaptation of the story included a misquote from Peter Fleming ‘NEHTA chief executive Peter Fleming says the original vision of a single e-health record system has been abandoned in favour of a Google or Microsoft-hosted "person-controlled" records’ . He did not say this nor was he quoted as saying this in The Australian article.

This has lead to an assumption that ‘person-controlled records’ is the same as the commonly known personal health records – records that are initiated and maintained by individuals.

Peter’s comment in The Australian article pertained to a design change of the proposed ‘person-controlled records’ system also technically known as the Individual Electronic Health Record (IEHR).

Previously, the design of the ‘person controlled records’ / IEHR focused on an e-health record for all Australians held on a centralised database. NEHTA is now working towards a system whereby, given medical information is currently stored in a number of different repositories and locations (private and public), information would be drawn from these existing sources through a single interface. This approach is preferred as it is able to be adopted more quickly to meet the needs of the Australian healthcare sector.

The work NEHTA is doing on healthcare identifiers, secure messaging and other technical standards would support a rollout of ‘person controlled records’ / IEHR by 2012, pending the decision by COAG on the business case put to it by NEHTA.

‘Person controlled records’ / IEHR records will be healthcare provider generated with healthcare providers owning and populating the records, and individuals controlling providers’ access to the information the records contain.

More here:

http://www.6minutes.com.au/articles/z1/view.asp?id=502244

15 October 2009

This was published in response to a short news item published a day or do earlier.

13 October 2009

“NEHTA chief executive Peter Fleming says the original vision of a single e-health record system has been abandoned in favour of a Google or Microsoft-hosted "person-controlled" records that can be adopted more quickly, writes The Australian.”

This is a very important statement from NEHTA, but not necessarily a good one.

What they are saying is that their IEHR will, using the IHI as a key, pull together a collection of patient information, format it, and with patient / consumer authorisation make what they can find available to a treating clinician.

Why may this not be a good idea?

Firstly experience overseas shows that such ‘assembled from source systems’ display approaches tend not to be sufficiently complete for clinicians to rely on them.

Second as we now know that the implementation of the IHI will be both phased in, and optional in actual use, the likelihood of safely and reliably assembling a reasonably comprehensive record for use by a new treating clinician can’t be very high anytime soon.

Third it will only take a few errors in allocation of IHI’s to individuals or clinical documents to have the wrong information retrieved. This will cause all sorts of issues regarding ongoing use of such a system.

Fourth the entire concept relies on healthcare providers making information available when requested but then being in the position of needing to seek consent from the patient to view other details on that same patient that may be held elsewhere. Once a patient says no the clinician will just go back to basic Q&A to obtain information in the old way – and all the potential benefits of a shared system are lost.

Fifth, of course no provider can be expected to open their systems for external lookup without both compensation and warranties as to security, now and in the future, of the requesting system.

Last all the issues of currency, which document is the most current and reliable etc will quickly emerge – as will all the issues about the information quality and format of the data that is being shared.

Take it from me to get all this right is, at best, a 5-10 year journey despite what NEHTA says about it being ‘adaptable quickly’.

I will watch with interest as all these issues are recognised and then, possibly, addressed.

Does anyone reading this believe NEHTA actually knows what it is doing? I certainly don’t.

David.