The NSW Health Minister Speaks Out On E-Health. She Is Not Impressed With Canberra So Far It Seems.

The NSW Health Minister spoke at a CEDA Conference last week and we have some interesting reports of the speech.

First we have

Fed Govt set e-health expectations too high: Skinner

Summary: The Australian Government has been slammed by the NSW Government for failing to meet expectations with its e-health record system, launched last weekend.

By Josh Taylor | July 3, 2012 -- Updated 21:45 GMT (07:45 EST)

New South Wales Health Minister Jillian Skinner has criticised the Federal Government for setting expectations too high on its 1 July e-health record launch.

Since Sunday, Australians have been able to register for a personally controlled e-health record (PCEHR), either via phone, in a Medicare office or by mailing in a form to Medicare. Much of the functionality for the system, including letting doctors put information in the records and connect their own systems to the PCEHR system, has yet to be implemented.

By contrast, NSW already boasts a substantial e-health record system in hospitals, with over 80 per cent of hospital beds covered with a system that keeps orders and results across the hospital, emergency departments and operating theatres. More than 75,000 clinicians have been trained to use the system, and it is utilised by 5000 unique users every day.

Speaking at a Committee for Economic Development of Australia (CEDA) lunch in Sydney yesterday, Skinner said that the NSW Government is working with the federal e-health system, but will not wait for it.

"We're continuing to move on, and we'll continue to move with them. We're not waiting for that, because I think it is so important," she said. "But I worry that the expectations that have been raised there, but people think they're going to have everything singing and dancing as of last Sunday. That is not the case. I think it was very slow to start, and it has gathered momentum now, but it was slow."

Much more here:

http://www.zdnet.com/fed-govt-set-e-health-expectations-too-high-skinner-7000000167/

Second we have

E-health record grind worries NSW Health

By James Hutchinson on Jul 4, 2012 7:00 AM

Halts internal projects.

New South Wales health minister Jillian Skinner has expressed disappointment at failed attempts to hit benchmarks set for the federally funded personally controlled electronic health record, which she claimed had held back plans for state-based e-health projects.

Skinner said that while the widespread uptake of the PCEHR "has the potential to revolutionise the medical practice", major issues still required resolution for the electronic health records project, which aims to provide individuals with a system that ties together information from GPs and hospitals.

The health minister pointed to data integrity as well management and access to records as key concerns she felt had not properly been resolved by the federal Department of Health and Ageing and lead agency the National E-Health Transition Authority.

.....

The $628.3 million PCEHR project went live for the first time on July 1, enabling Australian citizens to register for an electronic record in a Medicare office or by phone.

However, key components of the system — such as online registration, a consumer portal and compatibility with GP computer systems — failed to meet the deadline, set two years after the initiative was first announced.

.....

"The development of standards was very, very slow."

Lots more here:

http://www.itnews.com.au/News/307371,e-health-record-grind-worries-nsw-health.aspx

It is interesting that the Minister was more restrained in her criticism of the Commonwealth Programs in here prepared speech

Here is the link and text to the full speech.

http://www.health.nsw.gov.au/resources/minister/health/pdf/20120612.pdf

 Minister for Health and Minister for Medical Research

The Hon. Jillian Skinner MP

“The Future of Health in an Electronic World”

21 June 2012

Westin Hotel, Sydney

I acknowledge the traditional owners of the land

Chairperson Jane Treadwell, Editor FutureGov Magazine

Director-General, Department of Finance and Services: Michael Coutts-Trotter (Chair of NSW Government ICT Board)

Distinguished guests, ladies and gentlemen.

-----

Back in April 2010, as Shadow Health Minister, I told a gathering of ICT specialists about my conviction that ICT would play a dramatic role in improving the health of the people of NSW.

ICT will play a role, whether in acute hospital care, preventative health, patient self-care, treatments provided in a range of health care settings – in a patient’s home, in the community, a private or not-for-profit facility or through the public health system. And it will be delivered by a range of health professionals.

I said I wanted to be not just Health Minister, but e-Health Minister.

So given the priority that we have given to enhancing e-Health, it will not surprise this audience to hear that the NSW health system boasts one of the largest ICT portfolios of any government agency or corporate organisation in this country.

NSW Health will spend more than $1.5 billion over the next 10 years on ICT.

Our ambitious ICT portfolio has placed NSW Health at the forefront of building and driving the nation’s eHealth agenda.

Evidence shows there are many clinical care safety risks that can be reduced or even eliminated by integrating patient diagnostic, medication and medical history into a single, accessible electronic record, for example.

And we have developed numerous innovative eHealth programs across the health system.

For example:

·         We are employing Telehealth to link patients in rural and regional NSW with face-to-face specialist care in Sydney or anywhere else in the world for that matter, making services available anywhere, anytime.

·         We are collaborating with clinicians by activating voice recognition software in emergency departments to free-up precious time for patient care.

·         We have established real-time emergency department waiting time data for the community, published online and updated every 15 minutes.

·          We are ensuring that patients are the focus of the health system with technology now providing instant digital images, which can be reviewed and reported by specialist doctors even before the patient is back in the ward – slashing waiting times for results and delivering treatments earlier than ever before.

·         We are developing and introducing Apps and tablet technology to provide instant access to clinical research and digital medical libraries for better information sharing between clinicians.

·         We are supporting trials where Electronic health records have revolutionised the speed and accuracy of medical information between hospital wards and between patients and their GPs.

·         We are using Technology to better track financial and performance management, not only in clinical incident monitoring, but in preparations for an Activity Based Funding model and to ensure value for money for every tax-payer dollar spent.

These are not future ambitions – this is what happens today in many of our State’s hospitals, as we take advantage of the Information Age’s technological revolution.

Last year, I said that I wanted the NSW health system to lead the nation in e-health.

We are now delivering on that promise, with NSW Government commitments worth nearly $400 million in new ICT spending over the next four years.

NSW Health’s major ICT projects currently underway include:

·         *$170 million for a new electronic medications management system to prevent errors and reduce adverse drug events;

·         *$85 million on electronic medical records systems to improve patient tracking, clinical documentation, scheduling and reporting across a range of clinical specialties;

·          *$43 million on new clinical information systems to provide a single point that collates all relevant data to assist clinicians in our intensive care units. This system will also integrate with the electronic patient record and the medications management system.

We are also investing over $90 million to upgrade our corporate systems and to build new networks, data centres and messaging solutions, which will allow us to implement Telehealth on a wider scale. It will also allow for a common access email system that will connect all staff in all areas of NSW Health.

Our commitment to Health ICT is also evidenced by NSW Health becoming one of the three anchor tenants in the State’s new data centre - a vital component in the NSW Government’s ICT Strategy 2012.

At the hospital and Local Health District level, we need to continue to build new ICT systems and skill sets to address the equally important task of monitoring, collating and analysing the data we collect so that we can provide timely information to management.

As our tech-savvy workforce increases, we will get smarter and more innovative.

I want a resilient system, but one that is flexible and able to innovate to become more efficient. But above all, I want a health system that can deliver the highest quality care to patients.

In meeting these goals, Health has delivered a clinical ICT foundation across NSW, providing greater support to the patient journey through the health system.

Two important components of this clinical foundation are our electronic medical record and medical imaging capabilities.

The Electronic Medical Record, or EMR, allows clinicians to access a patient’s records from any location, at any time, to make rapid assessments and coordinate care.

NSW has now achieved a record level of electronic medical record maturity within our hospitals, with electronic orders, results, operating theatre and emergency department electronic records rolled out to more than 80 per cent of beds across the state.

Nowhere in the world can this level of coverage and interaction be found. With 75,000 clinicians using this patient record system, NSW leads the way with Australia’s largest e-health program, and the most comprehensive electronic health medical record system in use internationally.

This has not been without its failures and criticisms in relation to the initial implementations of EMR in hospital emergency departments – but site by site plans are now in place to maximise its efficiencies.

Voice recognition software is an example of maximising the benefits of EMR. In the recent trial at Manly Hospital, clinicians have the power to use their voice to navigate clinical systems and dictate medical decisions and treatment plans into a patient’s electronic medical record.

Doctors say they completed clinical documentation up to three times faster than they did previously and medical records were more complete and accurate.

Our Medical Imaging capability promotes radiologist productivity and gives electronic access to images across all public hospitals in NSW. Previously, medical images and reports were only available in hard-copy.

It saves money, it saves time and most importantly it speeds up patient treatment.

In the words of the clinical director of radiology at Westmead Hospital, “the new system has sped up the diagnosis and treatment of patients and replaced an out-dated system that was a clerical nightmare for radiologists.”

Or a junior doctor at Liverpool Hospital who reports, “I spent at least two hours trying to locate films for case meetings. With the new system, all the hospital’s images are available at the click of a button”.

And a senior surgeon at Nepean Hospital, “the system is invaluable for patients. For patients from Dubbo who want to be operated in Nepean, the surgeon can look at images and advise a time when the theatre is available and the surgeon is available. It could save up to three days waiting.”

While a number of new clinical programs are now being initiated, one of the most important will be Electronic Medication Management, which will prevent errors in prescribing by managing medications electronically - not having to decipher a doctor’s handwritten notes.

Medication errors remain the second most common type of medical incident reported in hospitals and, of all medication errors, omission or overdose of medicines occurs most frequently. Independent research has shown public hospital costs arising from adverse drug events and medication errors causing harm may be as high as $380 million per annum.

Reducing all errors will significantly improve patient safety and the quality use of medicines.

The NSW Government is spending $170 million on a new electronic medications management system to prevent errors and reduce adverse drug events, with pilot sites at Concord and St Vincent’s Hospitals.

Automating the system to provide standardised, legible, complete orders combined with clinical decision support systems, will not only reduce medication errors but has the potential to be one of the most important changes we make to patient care this decade.

Good communication about a patient’s clinical management is important in providing continuity of care across hospital and community healthcare settings.

NSW has three health sites implementing foundation work for the national Personally Controlled Electronic Health Records: Greater Western Sydney, Hunter Urban Division of General Practice; and St Vincents’ Mater Hospital.

At the core of enabling this work is a range of clinical information sharing for GPs including shared health summaries, medical images and discharge summaries from hospitals.

This allows information generated by a hospital visit, including treatment plans, images and test results to be viewed directly by GPs in their rooms, with their patients.

We are at the forefront of breaking down the often artificial barriers that can exist between hospitals, community healthcare and at home.

An excellent example of this work is the development of an electronic Blue Book and smartphone app, providing parents with mobile access to their child’s health records.

Every family currently receives a hard-copy of “My First Health Record” - a blue-covered book that collects important information on a baby’s milestones and immunisations, and other critical information for parents.

By creating the electronic Blue Book, we are firmly putting health care back in the hands of the consumer.

Parents will be able to update their records and, if they choose to do so, share that material with their health providers.

The smartphone app, now in its final stages of development, means a parent can have this material with them wherever they are, and whenever they need it.

Very soon, we look forward to rolling out the e-Blue Book to all parents who use the public health system in NSW.

Our success will be achieved through more than just technology and funding – it is achieved through good governance too.

Last year the Director General released her review into future governance arrangements for NSW.

A cornerstone of this review found that the statewide rollout of major eHealth systems needs to be supplemented with pervasive clinical engagement at the local level involving multiple testing and iterations of new systems before they are implemented.

To affirm NSW’s commitment to lead Australia in the development of eHealth, the NSW Government will establish eHealth NSW to embed leading practice and oversight of key ICT investments.

eHealth NSW will provide:

·         Greater collaboration between the central bodies and Local Health Districts

·         Genuine clinician involvement and leadership in decision-making at the Local Health District level

·         A more collaborative approach to planning and delivery

·         System-wide visibility to facilitate monitoring and sharing of best practice

·         More opportunity for local innovation, configuration to support local workflow and front line support

Advances in information technology offer important improvements in health care delivery.

Technology does not substitute for the high quality care provided by clinicians, rather it enhances it. By providing those same clinicians with the modern tools and information they need, when they need it, it will enable them to achieve so much more for their patients.

This is just a brief outline of some of the advances we are making in NSW Health so that we can put the patient first and improve the productivity of our vital health system.

I have great pleasure in officially opening the 2012 FutureGov Forum NSW and look forward to working with you to transform our health system through better use of technology.

----- End Speech.

It is useful to have the NSW perspective on e-Health put and to see that, at least for the present Ms Skinner is a supporter while being a little concerned about just how things are evolving.

One certainly gets the feeling she is starting to appreciate that e-Health might not be quite as easy as it first appears to deliver successfully - but being in the early phases of government the full difficulty and complexity may not yet have dawned.

Well worth a read - for understanding of what it hoped for. What happens the next few years will tell.

David.

Here Is Another Reason To Really Wonder About The Durability and Sustainability of the NEHRS.

A couple of interesting articles appeared last week which deserve wider exposure.

First we had.

After SCOTUS decision, health IT orthodoxy worth rethinking

By John W. Loonsk, MD, CMO CGI Federal

Created 07/03/2012

Now that the Supreme Court has upheld the substance of the Affordable Care Act (ACA), a collective sigh can be heard, of relief by some and frustration by others, but certainly of avoided tumult.

The focus of ACA attention will turn to results or repeal. And while a different decision could have had ACA become a weight on HITECH and health information technology (HIT), the principally bi-partisan nature of the HIT agenda should now refocus attention almost exclusively on results for it.

It is from this latter perspective, though, that there may still be HIT tumult to come. HITECH was constructed from a health IT orthodoxy (set of tightly-held, common beliefs) that has shown a few cracks of late. And some of these cracks have to do directly with the population health IT needs of health reform from a program (HITECH) that is principally built around individual patient transaction technology.

Through the EHR looking glass
Specifically, cracks have developed in the view, which HITECH shares, of EHRs as the center of the HIT universe. EHRs, and not other aspects of HIT, are the overwhelming focus of the incentive funds. The Meaningful Use criteria, tied to those funds, look at almost everything through an EHR lens. Either as cause or effect, criteria and leverage are pinned to EHR certification.

Taking this EHR focus to an extreme, recent policy discussion has even gone so far as to suggest that almost all health data, including even patient experience data, must be made to flow through EHRs. It is almost as if all the other health IT systems in hospitals, much less other health related organizations, never existed and EHRs need to carry the entire burden of HIT expectations.

Interestingly, a recent commentary in the New England Journal of Medicine by Ken Mandl and Isaac Kohane, has strongly criticized EHR software for its complexity and lack of flexibility. The authors have been trying to develop app-like health IT capabilities for an ONC grant and no doubt are frustrated by current EHRs as a platform. They put the blame for these issues squarely on EHR software vendors. But while EHR software may be complex right now, even at the “app store” you get what you pay for, and the current orthodoxy has the country paying specifically for EHRs. It is not clear that EHR vendors should be blamed for creating them or creating them with increasing complexity to meet all of the MU expectations. This is exactly what their clients are asking for because of the incentive structure.

.....

A new orthodoxy
The collective breath holding for the Supreme Court ruling on ACA can now be exhaled. But it is an opportune time to examine the current HIT orthodoxy and see if it needs refinement moving forward. There are lessons from the immediately visible cracks that need to be considered.

First, we need to expect outcomes from health IT to be more long than short-term and we should anticipate that we will need to have a robust infrastructure to fully get there. Second, since many of the needs for, and benefits of, health IT seem to relate more to population than to individual patient care outcomes, the orthodoxy should prioritize population health IT to a greater extent than the focus on EHRs alone will allow. And third, the orthodoxy should focus more on good quality data and less on software. This focus may not be comfortable for those who fear talking about data aggregation and trusted data users, but it will be a more resilient direction that is less likely to get hung up in specific software issues.

It looks like the Affordable Care Act may here to stay for a while – and now we probably need to consider a HIT orthodoxy 2.0 to better support health reform goals.

Lots more here:

http://www.healthcareitnews.com/news/after-scotus-decision-health-it-orthodoxy-worth-rethinking

And second we had:

Patient Engagement Requires Right IT Tools

Federal and private policy makers are insisting that healthcare providers get patients more involved in their own care, but that's not going to happen without a careful analysis of your IT strategy.

By Paul Cerrato,  InformationWeek
July 02, 2012
URL: http://www.informationweek.com//news/healthcare/policy/240003073

Health IT managers could learn a lot from my car mechanic. Mike once explained the difference between "parts changers" and real mechanics--those who are skilled diagnosticians. Parts changers will look at your ailing engine, make a snap judgment about what's wrong, replace the part he suspects is at fault, and hope for the best. A good mechanic, on the other hand, works through a diagnostic process, looking for subtle clues, and bringing his in-depth understanding of the internal combustion engine to bear to find the root cause of your problem.

As most healthcare providers know, the federal government is insisting that hospitals and practices improve their e-patient engagement strategy in order to meet Stage 2 Meaningful Use criteria. Private insurers are already going down this same path. When faced with such mandates, health IT executives and clinical leaders can take the parts changer's approach to patient engagement, or do a deeper root-cause analysis to find the best technology to address the issue.
Before analyzing the issue, it makes sense to carefully define it. Patient Engagement Systems, a company that develops IT tools in this niche, says: "Patient engagement is a process in which patients become invested in their own care. Engagement develops naturally when there is regular, focused communication between patient and provider, and it leads to behaviors that meet or more closely approach treatment guidelines."

So how do you get patients more invested in their own care? Technology is only part of the answer. An organization's core mission and its attitude toward patients are even more important. I've heard many people complain about arrogant, distant physicians, nurses, and front desk assistants who give them the impression they are doing them a favor by granting them an appointment.

In this age of customer satisfaction surveys and online provider review sites, that philosophy is woefully out of date. The best healthcare organizations genuinely believe that it's their privilege to serve, not the patient's privilege to walk in the door. And no amount of technological wizardry is going to have much of an impact without this core value.

But even in customer-savvy hospitals and practices that really love their patients, tech tools are no magic bullet. Some providers are placing their bets on mobile apps or active video games--think Wii--to foster wellness and lifestyle changes, encouraging patients to participate in "exergames" to lose weight and improve their cardiovascular system, for example. In theory, that approach should work, but research suggests otherwise.

Full article found in the link in the text.

As I read both articles what is being said is that the Health IT paradigm is changing and being updated in all sorts of interesting and complex directions and that all the assumptions - even those that are only a few years old - are under challenge and re-consideration.

It seems to me the NEHRS program - with is conceptual base in the late 1990’s is under threat of just slipping into irrelevance as easier and better ways are developed to share and disseminate health information. I really have no idea where things are headed but I suspect things will be way more surprising than we can either believe or imagine.

I get the sense there are exciting times ahead - and I suspect the NEHRS will need to radically change and adapt or die.

David.

The Scale Of The Miss On NEHRS / PCEHR Delivery Becomes Clearer Every Day. No Wonder We Got A ‘Soft Launch’ - It Wasn’t Ready.

The following appeared today.

NEHTA knew of PCEHR delays

• by: Karen Dearne
• From: Australian IT
• July 11, 2012 12:00AM

ALMOST all the functionality of the new personally controlled e-health record system is delayed until at least August, the National E-Health Transition Authority's head of the PCEHR program admitted four days before the go-live.

"At the moment, we are in the final stages of the production build-out and final verification testing," Andrew Howard told a vendors' webinar on June 27.

"Everything is on track for a successful launch (of the consumer portal and online registration system) over the weekend."

But Mr Howard said plans for the release of the provider portal were not yet settled.

"We're planning for the August timeframe, and those working with us in the test environments and the lead sites are tracking to that," he said.

"Final contracts will be put in place with (the national infrastructure consortium leader) Accenture this week around the specific date for delivery."

Accenture was awarded a $47 million contract to operate the new PCEHR system on June 26 for the two years to June 2014.

Last week, The Australian reported that Accenture had only delivered 40 per cent of a fully workable infrastructure by the July 1 launch date, while a hacking incident that occurred during the system's build late last year was not discovered for four months.

Mr Howard also confirmed that it is still unclear when the National Authentication Service for Health - which provides user verification, security and audit services - will be available from NEHTA's contractor, IBM.

"IBM has not delivered their contractual commitments as of yesterday (June 26), so we are in negotiations with them around a firm date for delivery," he said.

"So the NASH is not there, but we do have an interim solution for software vendors that will be in place for the August release (of the provider portal).

"The Health department has contracted with Medicare Australia to issue a gatekeeper compliant digital certificate which encompasses the NASH requirements for healthcare provider identifiers and healthcare organisation identifiers."

The plan to build the NASH arose from concerns that existing Medicare PKI infrastructure, used for billing and claiming purposes, was not robust enough for a national system transacting confidential medical information.

"A number of vendors have already tested that solution with us in the software testing environment, and we've also written the same sets of code off our reference platform to test the Medicare solution," Mr Howard said.

"So, with respect to secure connectivity to the PCEHR, we're still on schedule for August delivery as well."

But the state and territory governments have requested a one-year deferral on compliance with Healthcare Identifier provider requirements on hospital discharge summaries, as their systems are not ready.

Read much more of the details here:

http://www.theaustralian.com.au/australian-it/government/nehta-knew-of-pcehr-delays/story-fn4htb9o-1226422820967

Talking to those involved I have been told that this is all true and that it is probable a good many delays and hiccups are still to come.

I wonder when the point will come and we see the Minister summon a few executives in for a little fireside chat to obtain an explanation of just why it is the whole Program is looking rather like a mismanaged shambles.

Interestingly the problems have made their way across the Pacific to the US.

Monday, July 09, 2012

Australia Faces Problems in Rollout of Personal Health Record System

The Australian government has encountered problems with the recent launch of its Personally Controlled Electronic Health Record system, or PCEHR system, the Sydney Morning Herald reports.
The PCEHR initiative aims to let patients use an online tool to consolidate their records on medications, allergies, immunizations, doctors' notes and other health information.

Low Enrollment

The PCEHR project has faced low enrollment. Five days after the initiative launched on July 1, only 320 Australians had registered for the system.
The low enrollment numbers have led observers to express doubt that the program will meet its goal of registering 500,000 users in its first year.

Additional Problems

Users have reported several other problems with the PCEHR system, such as:

• Consistently busy call center lines;
• A lack of awareness among government staff that registration was open; and
• An inability to register names with apostrophes (Molloy, Sydney Morning Herald, 7/9).

http://www.ihealthbeat.org/articles/2012/7/9/australia-faces-problems-in-rollout-of-personal-health-record-system.aspx

It really seems the arrangement of having DoHA outsource delivery of the Program to NEHTA has been a less than good idea. One wonders if the Program  might not have been delivered more successfully if the whole Program (as a whole) had been passed to a private sector ‘managing agent’ with the sort of control and responsibilities needed to have something like this be delivered. Certainly it would have been good to see better governance, leadership and accountability than has now seemed to be the case.

I guess we will never know.

David.

I Think The NEHRS / PCEHR Is Becoming Political And That Just Might Be A Good Thing To Get Some Sensible Change.

There were a couple of articles appear in the last day of so on the PCEHR - interestingly reflecting that both the Fairfax Press and News Ltd are increasingly covering progress.

First we have:

Slower than predicted start for personal e-health records

Date July 9, 2012 - 1:38PM

Only 320 people signed up for an electronic health record five days after the Federal Government's much anticipated July 1 e-health launch.

With numbers like this, the Personally Controlled Electronic Health Record project, which aims to streamline patient medical records to facilitate treatment, is unlikely to meet its own target of registering 500,000 users by July 1 next year.

Australians wanting to consolidate their health records including medications, allergies, immunisations, doctor's and hospital notes and prescriptions, can apply online at ehealth.gov.au.

A slow, incomplete start was predicted in May for Australia's most ambitious e-health project to date.

However Paul Madden, deputy secretary and chief information officer of the Department of Health, insisted the slow start was a good thing.

"This is a really complex and complicated system and because it will be living in that very viral system called the internet, which we don't control, we have to take a very measured approach as we implement our system in there," he told IT Pro.

Early problems included constantly busy call-centre lines, the inability to register names that have apostrophes, and Medicare staff unaware that PCEHR registration was available. To register online, applicants are first redirected to the Australia.gov.au site to open an account with no apparent link back to the e-health record registration.

Despite the department undertaking a roadshow to promote e-health records, Madden said that there had been no promotion of the sign-up, hence fewer consumers would be affected by initial teething problems. He said the system could not be tested live until July 1 due to legislative restrictions.

Lots more detail here:

http://www.brisbanetimes.com.au/it-pro/government-it/slower-than-predicted-start-for-personal-ehealth-records-20120709-21qw4.html

Secondly we have a long article this morning

Auditor-General must audit e-health: Coalition

• by: Karen Dearne and Fran Foo
• From: The Australian
• July 10, 2012 12:00AM

PRESSURE is building for the Auditor-General to examine the cost and performance of parties involved in the Gillard government's personally controlled e-health record program after a dismal launch last week.

Opposition e-health spokesman Andrew Southcott said that given "almost $1 billion of taxpayers' money has been spent or allocated for this in the past two years, it would be prudent for the Australian National Audit Office to examine the PCEHR program".

IT projects were "notorious for costing a lot more than expected and delivering a lot less than expected, and this seems to be in that category".

"I think we've had very poor ministerial oversight of this project," Dr Southcott said. "The infrastructure is not ready, the National Authentication Service for Health, which provides user verification and system security, is not ready, consumers could not register online and the GPs' software is not ready -- I'm told one of the largest GP providers won't have software ready until next February.

"It's time to hear from the Health Minister, Tanya Plibersek, or in her absence the acting minister Mark Butler, to take ownership of the situation because this is unreal."

Two years ago, then health minister Nicola Roxon was "trumpeting a bright, new e-health future" but there's not much to show for it at this stage", Dr Southcott said.

The online registration portal finally launched on Friday night, after an abortive live session on Tuesday afternoon resulted in it being pulled offline.

Lots more here including a comment from your humble blogger.

http://www.theaustralian.com.au/australian-it/auditor-general-must-audit-e-health-coalition/story-e6frgakx-1226422011869

As pointed out in a comment yesterday, compared with what was promised two years ago we have been rather short changed.

See here:

http://aushealthit.blogspot.com.au/2012/05/its-time-to-check-what-we-were-promised.html

Now the call from the Opposition for an Audit of what has gone on with the overall E-Health Program seems pretty reasonable to me.

As we can see from the following it also seemed reasonable to the Audit Office in June 2011.

National e-Health Implementation

In the 2009−10 Budget, the Australian Government committed $57 million to e-Health to facilitate the transition of paper-based clinical recordkeeping to electronic means, in support of safer, more efficient and better quality health care. Over the period July 2009 to June 2012, the National e-Health Transition Authority Ltd (NEHTA) is responsible for delivering key components of the National e-Health Strategy, endorsed by Australian Health Ministers in late 2008. Building on the work of NEHTA, the Australian Government announced in the 2010–11 Budget an additional $467 million investment over two years in the key components of an electronic health record system, so that all Australians have access to a personally controlled electronic health record.

An audit would examine DoHA’s leadership, management and coordination of e-Health developments.

----- End Extract.

Here is the link.

http://anao.gov.au/html/Files/Audit%20Work%20Programs/2011AWP/HEALTH_Potential_audits.html

For mine - given that this has been a $1.0 Billion program - and such much smaller tasks - such as auditing the GP Super Clinic Program and actually underway - the time has well and truly arrived.

Additionally it seems clear the scope of the Audit needs to cover all Commonwealth funded (or partially Commonwealth funded activities NEHTA etc).

Given the result of the current poll -in less than 24 hours - where over 95% of 24 votes rate value for money low for this program the Audit Task and any required remedial action is becoming urgent.

Both Senator Boyce and Dr Southcott (the Opposition Spokespeople) have now spoken out on the need for an Audit. Time has come!
According to the Medical Observer Dr Southcott has said:
"he would write to the Attorney General to ask that the Australian National Audit Office examine how the government had spent “almost $1 billion” developing the records system."
See here:
http://www.medicalobserver.com.au/news/call-for-secure-messaging-as-coalition-demands-ehealth-audit
A good move I reckon.

David.