This Anonymous Comment Needs More Exposure and for Lots of Reasons.

Anonymous said...

David, not sure that this sort of "national enquirer" commentary really helps your status as a noted member of the e-health community.

Although I share your concerns, I simply don't believe that it is possible to divine the internal machinations of government by just looking at what is publicly released. There is SO much more happening behind the scenes that punters never get to see.

The tar-drip speed of progress can be mind-bending, but I am sure that the staff in government (including ALL of the people at DoHA and NEHTA who live and breathe this too) want to get it going. And they haven't stopped working yet. Nothing at COAG is final until the meeting is over.

Think more broadly for a moment: health identifiers are *really* close, national health reform is the dominant government story in the news right now, every health department is working at local e-health projects, PIP messaging vendors are making great progress, and the big defence e-health tender has just asked the open market to build a real implementation of almost all the technical elements outlined in the national e-health strategy.

There has never been a better set of circumstances to get the fire started. Don't let the smoke get in your eyes...

Tuesday, April 13, 2010 10:27:00 PM

----- End Comment.

Let us think what is being said here.

1. Anything useful that is happening is happening behind the scenes and no one other than the ‘in crowd’ can know.

2. The fact that the progress has been minimal for the last 5 years does not mean that great things are not close.

3. NEHTA and DoHA are toiling away on this and we should all trust that they will sort it out – and they don’t need anyone’s help.

4. You and the readers do not know what is going on and apparently nor should you.

5. Lie back, enjoy and trust us – and all will be well.

Now all this may be true, but the evidence we have from the press:

See here:

http://aushealthit.blogspot.com/2010/04/and-this-lot-think-they-can-implement.html

and from Senate Estimates seems to suggest it is just not true.

If you accept this stuff you must also believe in fairies in my view. I must be a ‘doubting Thomas’ who wants evidence, and after all these years I am one who has totally lost trust in the sort of person who thinks it is useful to post this material – but is so scared of their bosses they can’t use their name.

I am really rather ashamed of a country where this secrecy would be seen as normal behaviour – but maybe things have changed now we have Mr Rudd and Ms Roxon in charge.

It is now a decade since serious plans were outlined for a National E-Health approach with Health Online and we have hardly moved in terms of practical national delivery – accepting that some projects are seemingly making headway – but at a really ‘tar-drip’ speed - other than the essentially private initiatives around GP computing and messaging supported by some quite limited funds.

I also find it really silly that the details of any NEHTA / DoHA proposal to COAG or following meetings are not being discussed and reviewed openly. Perfect wisdom these people do not have – trust me on this small point! Let us be also totally clear the IEHR and Personally Controlled EHR proposals are both very bad and ill considered ideas that should not be funded.

Manifest leadership, strategy, governance, co-ordination, support, planning and so on are just absent - and in this environment we all know little of value is ever achieved.

Everyone knows who I am. Anonymous who are you to tell us you know better and that we should just relax and enjoy?

David.

We Are Led by Clueless Incompetent Nitwits. They Just Can’t Work Out What to Do – Pathetic!

The final offer for the COAG Health Reform Plan was released yesterday.

It was entitled:

A National Health And Hospitals Network: Further Investments In Australia’s Health

You can find the document here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/nhhn-report-2

On page 92 of the document we find the sole mention of e-Health

Next Steps

The Government will continue to make further investments in the National Health and Hospitals Network, in both the priority areas discussed in this document, and in additional important areas such as mental health, dental care and preventive health.

In mental health, while some progress has been made in recent years in providing more services to people with common conditions such as depression and anxiety, the system is not currently meeting the needs of certain groups of people with mental illness. In particular, young people with or at risk of mental illness are not accessing the timely care they need.

In dental health, many Australians experience poor access to dental care – often because there are not enough dentists and dental professionals. Current estimates project there will be a shortfall of 2.3 million dental services in 2020. People who are socially and economically disadvantaged are much more likely to have poor dental health. The Government is committed to expanding access to dental care in Australia, for example through the establishment of the Medicare Teen Dental Plan.

The Government recognises there is much more to be done to improve access to mental health services and dental care.

Obesity, tobacco and alcohol misuse are the key common risk factors for a range of chronic diseases, including diabetes, cancer and cardiovascular disease. Since 2007 the Commonwealth Government has made unprecedented investments in prevention, committing $872 million through COAG for preventive health programs to be rolled out in schools, workplaces and communities to help individuals modify their lifestyles to reduce the risk of chronic diseases. Nonetheless, the Government recognises there is scope for targeted further action to build on these important measures.

In addition, e-Health reforms will work to provide additional foundations to support improvements to the quality and efficiency of care across the National Health and Hospitals Network. The Government will be making further announcements on these reforms over the coming weeks and months.

Can you believe it? Weeks and months as Dr Oliver Frank, who sent me the document exclaimed! How long do we have to wait given we have known this is an issue since even Minister Abbott admitted he was struggling with the whole area in 2006-7!

Both sides of politics seem to be just utterly clueless and stupid.

What is going on is now utterly clear.

The work on E-Health done by NEHTA and DoHA is so hopeless that the Government was not even prepared to put it to COAG – for fear of being laughed out of the room!

I hope they can find someone who has a clue to help them and soon – or the overall quality of any Health Reform is doomed in my view.

The credibility of Mr Rudd and Ms Roxon in Health is basically shot as far as I am concerned. It is frankly terrifying that these people and their highly paid bureaucrats are in charge of what now looks like rendering terrible harm to a health system which, while stressed. does not need an axe taken to it - without real confidence some good will result.

Has someone told them there is actually a quite reasonable National E-Health Strategy they could get started with?

David.

AusHealthIT Man Poll Number 15 – Results - 13 April, 2010.

The question was:

Should NEHTA Be Attempting To Displace The Current Secure Messaging Providers?

Absolutely

- 7 (17%)

If There Is a Major Benefit to Clincians

- 10 (25%)

If There Will Be Savings Long Term

- 2 (5%)

They Should Let the Market Decide

- 13 (33%)

Absolutely No Way

- 7 (17%)

Total Votes: 39.

Comment:

I will leave the interpretation of the results to the reader. For me it seems clear that a significant number do not want NEHTA just using its Government mandate to disrupt already satisfactorily operating e-Health Infrastructure without some very good reason.

Thanks again to all who voted.

David.

And This Lot Think They Can Implement Health Reform? Not a Snowflake’s Chance in Hell.

The following appeared in the Australian today – April 13, 2010.

Work yet to start on e-health identifier

• Karen Dearne
• From: The Australian
• April 13, 2010 12:00AM

SIX months after assuring a Senate committee that the National E-Health Transition Authority was working with primary care software firms over the proposed national Healthcare Identifier system, the federal Health Department has conceded work is yet to begin.

"Currently there are no implementation projects within primary care being funded," a Health spokeswoman said last week.

The department was unable to supply a list of medical practice vendors previously said to be working with Nehta on an "implementation pathway" -- originally requested by Queensland Liberal Senator Sue Boyce in February amid questions about Nehta's activities.

.....

The Australian queried the list provided to the Senate, as many of the firms are not involved in the primary care software sector.

"As the work is still in its early stages, there is no list of primary care vendors currently available, other than those involved in the secure messaging work," the departmental spokeswoman said.

"The information is not incorrect.”

More here:

http://www.theaustralian.com.au/australian-it/work-yet-to-start-on-e-health-identifier/story-e6frgakx-1225852940454

Well sometimes the small articles are the really important ones!

The Orwellian quote "The information is not incorrect” just leaps from page and leaves one gasping!

After all the nonsense from DoHA and NEHTA about implementation dates and timetables for the HI Service the actual activity seems to be essentially a big fat zero.

This can’t be much less that systematic deception of the Senate, Ministers and the public can it?

No wonder, they are struggling to agree an approach to e-Health under the Rudd / Roxon health reform plan with this dazzling level of competence.

As an e-mail correspondent put it. ‘Off with their heads – the lot of them’!

Wanders off into the night sadly shaking head in disbelief!

David.

This Really Can’t Be Seen as a Full Package – What is Going On?

From the SMH this morning.

http://www.smh.com.au/national/elective-surgery-when-you-need-it-rudds-bold-pledge-20100412-s442.html

Elective surgery when you need it: Rudd's bold pledge

MARK METHERELL HEALTH CORRESPONDENT

April 13, 2010

THE Prime Minister has set his government the ambitious goal of ensuring that virtually all Australians needing elective surgery will get their operations in clinically recommended times.

Kevin Rudd last night released the final section of his of health reform proposals, a $650 million boost over four years to finance his promise that 95 per cent of patients get timely treatment.

But the government is holding back on declaring plans for four big problem areas previously targeted for reform: mental health, dental health, preventive health measures for obesity and alcohol abuse, and ''E-health'' or electronic health records.

This is despite the National Health and Hospitals Reform Commission's ''Denticare'' recommendation to ensure dental care for all Australians and its call for patient-controlled electronic health records to enable safer and more efficient care.

More here:

http://www.smh.com.au/national/elective-surgery-when-you-need-it-rudds-bold-pledge-20100412-s442.html

Does anyone understand why after all the reviews and discussion, all the reports and consultation we find ourselves in this mess – with grumpy Premiers and a determined PM just storming on?

I sure don’t.

David.

Yup - E-Health is Being Ignored! - Really Sad News.

Just listening to ABC's PM.

It seems the last roll of the dice is more funding for elective surgery ($600M over 4 years).

It will fund 90,000 surgeries over 4 years.

No money if the States do not sign on!

This is apparently the last offer for the COAG Meeting to be held on April 16, 2010.

The Premiers are chatting over the phone tonight to consider the final offer.

Mental Health and e-Health are totally left out it would seem.

Sad news and a reflection that NEHTA / DoHA can't put any convincing case for e-Health to Government.

Just pathetic!

David.

We Must Be the Next Cab off the Rank - Or Will E-Health Again be Ignored?

Think back a little over a month ago and we had the following from the Health Reform Team (Rudd / Swan / Roxon et al).

A National Health and Hospitals Network for Australia’s Future

Joint Release

Prime Minister

Treasurer

Minister for Health and Ageing

3 March 2010

The Rudd Government today announced major structural reforms to Australia’s health and hospital system.

The Government will deliver better health services and better hospitals by establishing a National Health and Hospitals Network.

This new national network will be funded nationally and run locally.

These reforms represent the biggest changes to Australia’s health and hospital system since the introduction of Medicare, and one of the most significant reforms to the federation in its history.

• A National Network: to bring together eight disparate State run systems with one set of tough national standards to drive and deliver better hospital services.
• Funded nationally: by taking the dominant funding role in the entire public hospital system the Australian Government will end the blame game, eliminate waste and shoulder the burden of funding to meet rapidly rising health costs.
• Run locally: through Local Hospital Networks bringing together small groups of hospitals, where local professionals with local knowledge are given the necessary powers to deliver hospital services to their community.

..... Lots left out from the middle or release.

On the basis of these reforms, over the coming weeks and months, the Government will announce critical additional investments to:

• train more doctors and nurses;
• increase the availability of hospital beds;
• improve GP services; and
• introduce personally-controlled electronic health records.

The establishment of the National Health and Hospitals Network builds on record investments in health and hospitals made by the Rudd Government over the last two years.

----- End Release.

The full release is here:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr10-nr-nr038.htm

Now of that list of additional announcements that we were told were coming we have now had (over the last 2-3 weeks) the following:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr10-nr-nr046.htm

Building a National Health and Hospitals Network - Training a Record Number of Doctors

and

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr10-je-je027.htm

Building an Australian Aged Care System: Commonwealth to Take Complete Responsibility for Aged Care

and

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr10-nr-nr064.htm

Strengthening Primary Care in Local Communities

The primary care area is important and is explained in more detail here:

Divisions will become primary health care organisations

by Michael Woodhead

Regional primary health care organisations will be built from the existing network of Divisions of GPs “so that they don’t create additional bureaucracy” the Prime Minister Kevin Rudd has announced today.

In an statement made in conjunction with health minister Nicola Roxon, the PM confirmed that a network of primary health care organisations will be set up as recommended in the National Health and Hospitals Reform Commission

He said the first primary health care organisations will be established by mid 2011, with funding to be confirmed in the May Budget.

The function of the new PHCOs will be to work with proposed Local Health and Hospital Networks to improve the delivery of integrated care, particularly for people with chronic diseases, he said.

More here:

http://www.6minutes.com.au/articles/z1/view.asp?id=515208

and here:

Govt reveals plans for division-primary care evolution

12th Apr 2010

Shannon McKenzie

THE landscape of primary care is set to be overhauled with the Federal Government today unveiling plans to transform divisions of general practice into primary health care organisations.

The move has long been expected following its recommended by two independent think tanks – the National Health and Hospitals Reform Commission and the Primary Health Care Strategy External Reference Group – last year.

According to plans announced by Prime Minister Kevin Rudd and Health Minister Nicola Roxon the primary health care organisations (PHCOs) will ensure better collaboration between primary health care, allied health and hospital services.

PHCOs will also work to identify groups that are unable to access primary care services, and will have a particularly focus in securing services for patients with chronic conditions.

The Government also flagged a larger role for the PHCOs down the track.

More here:

http://www.medicalobserver.com.au/news/govt-reveals-plans-for-divisionprimary-care-evolution

In addition we have had announcements on regional cancer centres, diabetic care and indeed a pretty big one on emergency care over the last weekend.

See here:

Rudd's emergency ward funds welcomed

April 11, 2010

Prime Minister Kevin Rudd has put another sweetener on the table to help get the states and territories to agree to his health reform package.

He has offered $500 million in funding to help cut waiting times in public hospital emergency wards.

Under the plan, hospitals will be given $150 million to help improve services in emergency departments from July this year.

Federal Health Minister Nicola Roxon says another $350 million will be allocated to hospitals that meet targets to cut waiting times.

More here:

http://www.abc.net.au/news/stories/2010/04/11/2869586.htm

As Peter Cundall was prone to saying this now – after the rush of releases on today – April 12, 2010 – looks like ‘your bloomin’ lot’, except for e-Health.

Both ends of the hospital system are now at least partially de-stressed, more docs and other staff and more primary and preventive care – all we need is some decent co-ordination as E-Health could help provide.

One gets the sense that with a good number of Premiers seemingly not all that happy and a number of expert commentators coming out and saying the Brumby Plan needs a close look – the ground might be moving to a rather more consultative approach as to how reform is to get done.

One thing that must change is that we are told – and soon – what the e-Health plans are – so that if they are as absurd as we seem to be hearing from both Melbourne (IEHR’s) and Canberra ( personally-controlled electronic health records) there will be some comment time available to push for more sensible and strategic first steps.

We have waited for a long time for some sensible funds to back up implementing the National E-Health Strategy. This has the feel that the last roll of the dice is very near indeed!

David.

Formal Blog Policy Change - Comment Rejection Policy

Over the last few weeks I have noticed an increase in the number of Anonymous comments that are personally rather than content and ideas directed.

As of now, these comments will simply be rejected at my total discretion. Any comment related to the content of and ideas contained in the blog - other than those fussing about punctuation, grammar and the like - will, of course, be published.

If there is an error in these areas - e-mail works fine and I will do my best to fix the issue if I can work out what it is!

I simply will not tolerate Anonymous personal abuse and will not publish same here. On the other had the free flow of ideas and discussion is greatly valued by both myself and the readers I believe. Be assured I will do nothing to censor the free flow of ideas - cookey, wrong headed or not!

Anonymous posting serves a useful function here, but life is just too short to put up with Anonymous and abusive smart asses - most of whom are pushing paid agendas.

If you don't like the policy set up your own blog and go for it!

David.

p.s. My policy of simply rejecting comments trying to insert commercial links to potency pills, fraudulent offers and the like will also remain.

D.