Last week we had the following announcement from NEHTA.
http://www.nehta.gov.au/index.php?option=com_content&task=view&id=182&Itemid=144
“NEHTA sets direction for electronic messaging in health
NEHTA confirms Health Level 7 as the national standard for the electronic messaging of health information across Australia.
Across the Australian healthcare sector there are many different types of computer software and systems that are involved in the exchange of information. Currently, these systems use various exchange formats to send and receive information. To ensure that all systems across Australia have the ability to reliably and safely communicate with each other, a standard exchange format is required. The National E-Health Transition Authority (NEHTA) has determined that this standard will be based on the HL7 family of standards.”
NEHTA's roadmap for deployment and adoption is outlined later in the press release:
“To assist the health IT sector to migrate to this standard, NEHTA has identified the following approach:
a. Where HL7 version 2.x standards are already extensively used and yielding benefits, for example pathology and patient administration, these standards should continue to be supported. Where HL7 standards are not in use, they should be factored into system upgrades where practicable.
b. NEHTA will now focus on developing Web services specifications based on work undertaken by the HL7 Services Specification Project (HSSP), and content specifications based on the HL7 Clinical Document Architecture – Release 2 (CDA R2) for areas such as referral, discharge, prescribing, dispensing and pathology.
c. This work will then form the basis by which industry will migrate to HL7 version 3.”
This is really quite a large ‘change’ or dare I say ‘leap’ for NEHTA – so large in fact that a search of NEHTA’s “National E-Health Standards Catalogue - Supporting Standards Implementation - Version 2.0 - 19/01/2007” (8 weeks ago) does not have a single reference to HL7!
This is actually quite surprising given that HL7 V2.x was recommended by DH4 for continued use by the Australian Health Sector over 12 months ago and indeed it is widely deployed and Standardised nationally.
What is of major concern is not that NEHTA can show flexibility, but that they can show so much flexibility in moving from their previously announced path to this current path so quickly. Quite frankly, to put it bluntly this is not how Standards Development Organisations – even amateur ones – should behave. Were I a Health IT developer who had invested time and money in responding to NEHTA's previous Generic SOA approaches I would surely be suggesting that I would like my money back (with interest)!
This kind of strategic instability reflects a serious lack of real industry consultation over the last three years. There should be some accountability moment or action associated with this switch.
It is also difficult to understand why in NEHTA’s document entitled “Guidelines for Implementing Interoperable Web Services Version 1.0 – 28 March 2007” there does not seem to be any mention of either HL7 or HSSP. A comment as to where this new direction for interoperability with HL7 and HSSP fitted with this implementation guideline would have been useful and informative to everyone!
Indeed the delay in coming to a view of the place of HL7, given the expertise and advice available to NEHTA, is really unconscionable and has been a major barrier to e-health progress. One could have expected strategic clarity in the area much before this.
One must also wonder with the decision to deploy content based on CDA R2 just where all the NEHTA Clinical Data Specification work fits and how much of this will need to be altered or reviewed to conform with the HL7 Reference Information Model? It would also be interesting to know how all this fits with the long delayed but imminent Shared EHR announcements.
A final point - does anyone else think making a decision like the HL7 decision warrant a process of open public discussion and not simply an ex-cathedra announcement. Some of us don't worship at that sort of church!
Talk of the right hand not knowing what the left hand is up to.
David.
Thursday, March 29, 2007
Tuesday, March 27, 2007
An Even Better Use for the Future Fund Money.
It seems that the Labor Party recognises that there are some pieces of technical infrastructure that require an element of Government funding to bring into existence, but that once implemented there will be ongoing benefit for the nation.
The essence of their internet broadband announcement is as follows:
“Federal Labor will revolutionise Australia’s internet infrastructure by creating a new National Broadband Network.
It will connect 98 per cent of Australians to high speed broadband internet services – at speeds over 40 times faster than most current speeds.
With the rollout of a new ‘Fibre To The Node’ (FTTN) network, Federal Labor will increase speed to a minimum of 12 megabits per second – so fast that household entertainment, business communication and family services will happen in real time.
The remaining two per cent of Australians in regional and rural Australia not covered by the FTTN network will have improved broadband services.
New services and benefits of the network – particularly in rural and regional areas – include:
• Slashed telephone bills for small business;
• Enhanced business services such as teleconferencing, video conferencing and virtual private networks;
• Enhanced capacity for services like e-education and e-health; and
• High definition, multi-channel and inter-active TV services.
It is estimated that the new National Broadband Network will deliver national economic benefits including:
• Up to $30 billion in additional economic activity every year;
• Making Australian small businesses more competitive;
• Creating new markets for businesses and new jobs for Australians; and
• Extending media diversity.
A Rudd Labor Government will:
• Partner with the private sector to deliver the national broadband network over five years;
• Undertake a competitive assessment of proposals from the private sector to build the network;
• Ensure competition in the sector through an open access network that provides equivalence of access charges and scope for access seekers to differentiate their product offerings;
• Put in place regulatory reforms to ensure certainty for investment; and
• Make a public equity investment of up to $4.7 billion.
This commitment will be financed from existing government investment in communications, including the $2 billion Communications Fund and through the Future Fund’s 17 per cent share in Telstra, which will earn dividends and be sold down to a normal market level after November 2008.”
It seems to me this is just the first step. No point in having train lines (i.e. the broadband network) if you don’t have trains (e.g. e-health) to take advantage of it!
Given that there is a clear business case for increased spending in the Health IT domain – with net benefits estimated at up to $A5.0 Billion per annum or more (based on studies undertaken in the US, UK and Canada) what could be a better use of a little more of the Future Fund than to kick start e-health with an investment designed to deliver a real return once implemented?
A sensible approach would to be develop a National E-Health Strategy, Business Case and Implementation Plan as a first step and to then establish an highly accountable implementation organisation – maybe modelled on the UK or Canadian models or a mixture of the two – with a focus on making sure the lessons learnt from both are properly absorbed. (While I plan a separate article on this area in the future the need for local involvement, ownership and choice in the context or appropriate standardisation and central direction setting now seem obvious for any national initiative.)
The Future Fund has as its objective a return of 7.5% + inflation over the long term I understand. It would seem this return could be achieved with expert project management and the deployment of Health IT is a way that is known to have beneficial impacts (i.e. use of advanced clinical workstations, in depth automation of investigative services and supply chains, improved secure messaging and the use of systems wherever possible with advanced clinical decision support). Measurement and well as realization of the return on investment I recognise will be a considerable challenge but should not be impossible. There is no doubt the econometric tools exist to undertake such work exist.
The main issue that will almost certainly emerge will be how the benefits achieved will be cashed out for return to the Future Fund – given the tendency of the Health Sector to aim to expand services when efficiencies are obtained rather than take the cash benefit.
I believe the scale of the return on investment in this sector is likely to mean that both some service expansion as well as cashing out of benefits will be possible – to everyone’s pleasure.
Health IT is an ideal candidate for a major planned capital investment and will both make a profit and do good things for the users of, and workers in, the Health Sector.
Let’s give it very careful thought.
David.
The essence of their internet broadband announcement is as follows:
“Federal Labor will revolutionise Australia’s internet infrastructure by creating a new National Broadband Network.
It will connect 98 per cent of Australians to high speed broadband internet services – at speeds over 40 times faster than most current speeds.
With the rollout of a new ‘Fibre To The Node’ (FTTN) network, Federal Labor will increase speed to a minimum of 12 megabits per second – so fast that household entertainment, business communication and family services will happen in real time.
The remaining two per cent of Australians in regional and rural Australia not covered by the FTTN network will have improved broadband services.
New services and benefits of the network – particularly in rural and regional areas – include:
• Slashed telephone bills for small business;
• Enhanced business services such as teleconferencing, video conferencing and virtual private networks;
• Enhanced capacity for services like e-education and e-health; and
• High definition, multi-channel and inter-active TV services.
It is estimated that the new National Broadband Network will deliver national economic benefits including:
• Up to $30 billion in additional economic activity every year;
• Making Australian small businesses more competitive;
• Creating new markets for businesses and new jobs for Australians; and
• Extending media diversity.
A Rudd Labor Government will:
• Partner with the private sector to deliver the national broadband network over five years;
• Undertake a competitive assessment of proposals from the private sector to build the network;
• Ensure competition in the sector through an open access network that provides equivalence of access charges and scope for access seekers to differentiate their product offerings;
• Put in place regulatory reforms to ensure certainty for investment; and
• Make a public equity investment of up to $4.7 billion.
This commitment will be financed from existing government investment in communications, including the $2 billion Communications Fund and through the Future Fund’s 17 per cent share in Telstra, which will earn dividends and be sold down to a normal market level after November 2008.”
It seems to me this is just the first step. No point in having train lines (i.e. the broadband network) if you don’t have trains (e.g. e-health) to take advantage of it!
Given that there is a clear business case for increased spending in the Health IT domain – with net benefits estimated at up to $A5.0 Billion per annum or more (based on studies undertaken in the US, UK and Canada) what could be a better use of a little more of the Future Fund than to kick start e-health with an investment designed to deliver a real return once implemented?
A sensible approach would to be develop a National E-Health Strategy, Business Case and Implementation Plan as a first step and to then establish an highly accountable implementation organisation – maybe modelled on the UK or Canadian models or a mixture of the two – with a focus on making sure the lessons learnt from both are properly absorbed. (While I plan a separate article on this area in the future the need for local involvement, ownership and choice in the context or appropriate standardisation and central direction setting now seem obvious for any national initiative.)
The Future Fund has as its objective a return of 7.5% + inflation over the long term I understand. It would seem this return could be achieved with expert project management and the deployment of Health IT is a way that is known to have beneficial impacts (i.e. use of advanced clinical workstations, in depth automation of investigative services and supply chains, improved secure messaging and the use of systems wherever possible with advanced clinical decision support). Measurement and well as realization of the return on investment I recognise will be a considerable challenge but should not be impossible. There is no doubt the econometric tools exist to undertake such work exist.
The main issue that will almost certainly emerge will be how the benefits achieved will be cashed out for return to the Future Fund – given the tendency of the Health Sector to aim to expand services when efficiencies are obtained rather than take the cash benefit.
I believe the scale of the return on investment in this sector is likely to mean that both some service expansion as well as cashing out of benefits will be possible – to everyone’s pleasure.
Health IT is an ideal candidate for a major planned capital investment and will both make a profit and do good things for the users of, and workers in, the Health Sector.
Let’s give it very careful thought.
David.
Monday, March 26, 2007
It's Nice to See The System Working!
This arrived today via Her Majesty's Post in response to my open letter of a week or so back.
Next step is to see what the Department's officers make of the suggestions and comments to be found here!
I wait with bated breath.
David.
Next step is to see what the Department's officers make of the suggestions and comments to be found here!
I wait with bated breath.
David.
Sunday, March 25, 2007
Imminent Fiasco Alert – SA HealthConnect running off the Rails.
I suspect there must be something in the water that reaches
For background on this project go to my post of late last year.
http://aushealthit.blogspot.com/2006/12/children-of-healthconnect-how-are-they.html
The Table of Project Activities says it all! What is described in the table is an absolute and incompetent disgrace which is even worse than some of the bungled HealthConnect trials of years gone by. It is chaotic and absurd in the way it is being organised and the table of activities shows those involved have no idea what they are doing. Just consider the following past and future sequences carefully.
--------------------------------------------------------------------------------------
February 2006 - Functional specification drafted
July 2006 - Care Planning Trial commenced
October 2006 - Commenced consultations with NEHTA re standards and data specifications and local groups, e.g. Health Provider Index (ongoing)
November 2006 - Care Planning Trial Go Live
February 2007 - Consumer Reference Group and Stakeholder Reference Group formed
Mar/April 2007 - Tender documents released to market
March 2007 - Communications plan developed
May 2007 - Tender responses due
May 2007 - Interim findings of the Care Planning and Communication Trial due
November 2007 - Care Planning and Communication Trial concludes
Late 2007 - State-wide implementation begins
-----------------------------------------------------------------------------------------
When considering the program – what does one see?
First, essentially out of the blue, HealthConnect SA caused a requirements specification for Care Planning (which has not been disclosed) to be drafted. On the basis of this specification it seems a trial of some commercial software has been commenced. The trial went live, it is claimed, in November 2006. It is quite clear the selection process was neither thorough nor open given the time it took, the apparent absence of a tender and the non-publication of full evaluation criteria.
What is claimed (on the project web site) is that the Ozdocsonline was selected by the following process:
“Consultations undertaken with key stakeholders identified that, in order for the care planning and communication system to be effective, it must:
- improve health outcomes
- be simple
- protect patient privacy
- provide patient access and control
- facilitate communication and collaboration between the health care team
- be accessible at the point of care.
Based on these criteria, and following an assessment of existing care planning systems, the Ozdocsonline system was selected for the trial. “
Hardly the level of detailed requirements needed to determine the appropriate system for a twelve month trial.
But – whoops! – it seems someone noticed that the trial now underway (despite its use of both state and federal funds) is hardly the type of non-standard, non-integrated system or approach NEHTA (or anyone else who had a clue) would choose to sponsor without solid evaluation as to alternatives.
So what happens?
In February 2007, presumably after a little 'jawboning' from NEHTA or DoHA, suddenly we see the actual formation of some management and consultative committees and the beginning of consumer and stakeholder consultation. Bit late since the trial has already been underway for four of its twelve months.
Presumably the Communications Strategy mentioned for March 2007 is to provide ‘spin control’ for the impending mess!
One also has to wonder how much pressure was exerted to spend committed funds with such haste concurrent with the establishment of such a large team (16 people in total in the group as of March 2007).
What happens next should be fascinating! A tender for a longer term solution is to be issued in March 2007 – but this is being done in the absence of any input from an interim evaluation of the first half of the trial – let alone a completed evaluation of the 12 month effort!
The responses to the tender specifications (whose requirements are presumably based on gut feeling of what might work rather than evidence of what is actually working) and the evaluation report of the tender are to be completed at the same time.
There is nothing like planning for success! This is an excellent example of the saying ‘If you fail to plan, you plan to fail. ’According to the timetable the tender will get evaluated, a solution will be selected, consultations will be held and State-wide implementation will begin by late in 2007!
Oh, and also – in November 2007 the trial closes down and all the data vanishes, unless the unsuitable incumbent as far as NEHTA's standards (and common sense) are concerned gets retained on a permanent basis or practitioners start paying to retain their own information.
Even more amazing is the following from the Project Site
“The South Australian Care Planning Project will also need to undertake work to:
- Ensure the care planning system conforms, where possible, with the National e-Health Transition Authority's (NeHTA) standards for care plans.
- Ensure that the Health Provider Registry, developed and maintained by SA Divisions of General Practice Inc (SADI), includes allied health providers.
- Ensure the care planning system has decision support capability.”
Firstly – It is important to note that, as far as I know, there are no such things as NEHTA Standards for Care Plans (they certainly do not exist anywhere in the NEHTA Standards Catalogue), if indeed there are any recognized Australian Standards in the domain at all sanctioned by Standards Australia or the like. Second NEHTA is developing a National Health Provider Identifier which presumably will obsolete the local SADI effort – so just what is being planned here? Thirdly the vagueness of “Ensure the care planning system has decision support capability” is both vague and meaningless – especially given that addition of any really useful decision support to any care planning system is a major and complex undertaking which does not seem to be contemplated in this one-liner and certainly not in the time-frames proposed above.
While not wishing to be unreasonably critical (I am really keen there be ongoing development in the e-health space a quickly as possible) , it just seems to me this whole project is the wrong way to be going and is very far from what should be funded to further develop e-health. There is a real risk, I believe, that a serious waste of money and effort is occurring. I will happily publish here on the blog any reasoned explanation from the proponents of all this that can show I have got it wrong and that this is a well managed, strategically sensible, standards aligned, coherently planned, transparent and properly executed pilot and project.
Am I the only one who can see how silly and bizarre all this is, how poorly thought through it is, how it is lacking in any reasonable process, and how its chances of and substantive long term success are miniscule at the best?
David.
Thursday, March 22, 2007
HL7 to Assist Australian E-Health Development
The following was released by HL7 today.
==================
22 March 2007
MEDIA RELEASE
NEHTA confirms Health Level 7 as the national standards for the electronic messaging of health information across Australia.
Across the Australian healthcare sector there are many different types of computer software and systems that are involved in the exchange of information. Currently, these systems use various exchange formats to send and receive information. To ensure that all systems across Australia have the ability to reliably and safely communicate with each other, a standard exchange format is required. The National E-Health Transition Authority (NEHTA) has determined that this standard will be based on the HL7 family of standards.
"This decision provides a clear national direction. Those who develop these systems now have certainty about what the Australian customers of their systems will require," said Dr Ian Reinecke, Chief Executive of NEHTA. "Without all systems in the healthcare sector using common standards such as this, the promise of electronic health communication can't be fulfilled on a national scale."
"The endorsement of the HL7 standards by NEHTA is good news for the Australian e-health community and an acknowledgement of the value and maturity of HL7 standards in a global context. We look forward to working with NEHTA to develop the support required for industry to implement this national direction," said the Chairman of HL7 Australia and Board Member of HL7 globally, Mr Klaus Veil.
To assist the health IT sector to migrate to this standard, NEHTA has identified the following approach:
1. Where HL7 version 2.x standards are already extensively used and yielding benefits, for example pathology and patient administration, these standards should continue to be supported. Where HL7 standards are not in use, they should be factored into system upgrades where practicable.
2. NEHTA will now focus on developing Web services specifications based on work undertaken by the HL7 Services Specification Project (HSSP), and content specifications based on the HL7 Clinical Document Architecture – Release 2 (CDA R2) for areas such as referral, discharge, prescribing, dispensing and pathology.
3. This work will then form the basis by which industry will migrate to HL7 version 3 .
This approach ensures that migration occurs in a consistent manner, and in conformance with NEHTA's requirements.
"NEHTA will work closely with HL7 Australia and Standards Australia in this development work," said Dr Reinecke. "In addition, NEHTA is closely liaising with its international counterparts - such as the UK's National Health Service and Canada's Health Infoway - to ensure that the specifications developed in Australia are consistent with international efforts."
This direction is consistent with the endorsement of HL7 standards for use in Australia by the National Health Information Group in 2004. In the international community, the largest adopter of HL7 v3 standards is the Connecting for Health program run by the UK's National Health Service; the UK, US and Canada have also adopted HL7 CDA specifications.
A report providing further details on this decision will be released shortly by NEHTA. Further information about HL7 standards can be found at www.hl7.org.au.
====================
It must be said it has taken rather too long to get some basic clarity and to permit further e-health development to be undertaken with some confidence.
The decision is, however, most welcome. Whether it is the right one only time will tell.
David.
==================
22 March 2007
MEDIA RELEASE
NEHTA confirms Health Level 7 as the national standards for the electronic messaging of health information across Australia.
Across the Australian healthcare sector there are many different types of computer software and systems that are involved in the exchange of information. Currently, these systems use various exchange formats to send and receive information. To ensure that all systems across Australia have the ability to reliably and safely communicate with each other, a standard exchange format is required. The National E-Health Transition Authority (NEHTA) has determined that this standard will be based on the HL7 family of standards.
"This decision provides a clear national direction. Those who develop these systems now have certainty about what the Australian customers of their systems will require," said Dr Ian Reinecke, Chief Executive of NEHTA. "Without all systems in the healthcare sector using common standards such as this, the promise of electronic health communication can't be fulfilled on a national scale."
"The endorsement of the HL7 standards by NEHTA is good news for the Australian e-health community and an acknowledgement of the value and maturity of HL7 standards in a global context. We look forward to working with NEHTA to develop the support required for industry to implement this national direction," said the Chairman of HL7 Australia and Board Member of HL7 globally, Mr Klaus Veil.
To assist the health IT sector to migrate to this standard, NEHTA has identified the following approach:
1. Where HL7 version 2.x standards are already extensively used and yielding benefits, for example pathology and patient administration, these standards should continue to be supported. Where HL7 standards are not in use, they should be factored into system upgrades where practicable.
2. NEHTA will now focus on developing Web services specifications based on work undertaken by the HL7 Services Specification Project (HSSP), and content specifications based on the HL7 Clinical Document Architecture – Release 2 (CDA R2) for areas such as referral, discharge, prescribing, dispensing and pathology.
3. This work will then form the basis by which industry will migrate to HL7 version 3 .
This approach ensures that migration occurs in a consistent manner, and in conformance with NEHTA's requirements.
"NEHTA will work closely with HL7 Australia and Standards Australia in this development work," said Dr Reinecke. "In addition, NEHTA is closely liaising with its international counterparts - such as the UK's National Health Service and Canada's Health Infoway - to ensure that the specifications developed in Australia are consistent with international efforts."
This direction is consistent with the endorsement of HL7 standards for use in Australia by the National Health Information Group in 2004. In the international community, the largest adopter of HL7 v3 standards is the Connecting for Health program run by the UK's National Health Service; the UK, US and Canada have also adopted HL7 CDA specifications.
A report providing further details on this decision will be released shortly by NEHTA. Further information about HL7 standards can be found at www.hl7.org.au.
====================
It must be said it has taken rather too long to get some basic clarity and to permit further e-health development to be undertaken with some confidence.
The decision is, however, most welcome. Whether it is the right one only time will tell.
David.
Wednesday, March 21, 2007
What a Difference a Presentation Makes!
Seems the Health E-Nation Conference that was organised by CHIK Services on 21 March, 2007 has had an interesting outcome.
It seems NEHTA has recognised, in its presentation, that there are Standards in place and in use that can’t be ignored and that the approach of the ‘jackboot’ as opposed to real consultation can lead to embarrassment! All of us in the health sector could have told them that three years ago!
At last – after three years – maybe we will see some sanity emerge. The steps announced to continue with use of HL7 V2.x are a useful first step.
Much, much more pragmatism, commonsense and flexibility is required – as is a real understanding of the Health Sector’s needs – but this step offers a minute glimmer of hope.
Well done – and how about some serious next steps!
I wonder will it be followed up with a range of other sensible moves - most especially the development of a National e-Health Development approach?
This blog is not short on suggestions on areas that could be fruitfully reviewed.
David.
It seems NEHTA has recognised, in its presentation, that there are Standards in place and in use that can’t be ignored and that the approach of the ‘jackboot’ as opposed to real consultation can lead to embarrassment! All of us in the health sector could have told them that three years ago!
At last – after three years – maybe we will see some sanity emerge. The steps announced to continue with use of HL7 V2.x are a useful first step.
Much, much more pragmatism, commonsense and flexibility is required – as is a real understanding of the Health Sector’s needs – but this step offers a minute glimmer of hope.
Well done – and how about some serious next steps!
I wonder will it be followed up with a range of other sensible moves - most especially the development of a National e-Health Development approach?
This blog is not short on suggestions on areas that could be fruitfully reviewed.
David.
Tuesday, March 20, 2007
Software Quality Assurance – What do we Need and must Demand?
A number of elements have come together over the last few weeks to have me thinking about the expectations we should have of the software and systems we deploy to aid the delivery of clinical care.
First there was a very lively discussion that emerged on the GP_TALK e-mail list which discussed the various issues that surround the handing of clinical results arriving into Patient Management Systems. The discussion was triggered by a question on just what the legal responsibilities were to monitor the incoming areas for arriving results from pathologists, radiologists etc and who was legally liable if an important result went astray and just what the dividing line, if any, was between the test orderer, the result provider and the result receiver / reviewer.
The interest in this topic is considerable because of previous legal liability decisions which make it clear it is the court's view that when a clinician orders an investigation which has the possibility to reveal 'clinically significant' information the practitioner has a considerable legal onus upon them to ensure they have systems in place to ensure that they will, within a reasonable period of time, note and act on the results as they are received.
Second there have been a number of concerns expressed by a range of authorities considering what expectations should be held for the functionality, reliability, usability and clinical safety of software designed to be used by clinicians. This is seen as encompassing areas such as scope, currency, accuracy and reliability of clinical decision support, the aspects of the system design that facilitate safe and consistent use of the software as well as the overall functionality offered.
Third the CEO of HealthLink (Mr Tom Bowden) recently wrote a discussion paper highlighting the problems that can arise if there is not 'end to end' accountability for the entire investigation ordering cycle – covering ordering, processing, resulting and review. This paper clearly recognises the need for substantive co-operation between clinical messaging providers and developers of clinician systems to ensure highly effective integration and the practical removal of any risk of important information 'falling between the cracks'.
This paper – in its current version – can be found at the following URL
http://www.healthlink.net/healthlink_documents/brochure/Electronic%20messaging%20safety%20Issues%20-%20HealthLink%20viewpoint.pdf
Fourth, as best I can tell, NEHTA has articulated no policies or plans in the area of clinical software quality and safety to date, and has not been sponsoring any publicly announced programs in the area.
Fifth, if discussions in GP e-mail forums are to believed, there are some real issues regarding to responsiveness of providers of GP software to both functional gaps and ‘bugs’.
Lastly, to date, while there has been medical software industry contribution work to support the health information Standards development process, there have been limited real outcomes in terms of data portability and interoperation between GP applications. We lack any Australian Standards for patient data portability, for medical software quality and for the quality of functionality and decision support provided.
None of these issues are exactly new, but their emergence does serve to highlight that there are considerable risks associated with having an e-health environment which is fragmented in terms of how quality and safety issues are addressed.
What is needed is really quite clear – a clear division of labour as to who is responsible for which part of the information chain and accountability on the part of all to deliver as fail-safe and reliable solutions as is humanly possible.
It seems to me there needs to be some form of national round table convened which brings together the patient management system developers, the messaging providers, result providers, expert clinicians and health informaticians to develop a framework under which responsibility for each part of the chain can be identified and those involved can then work to develop approaches and solutions which will solve the problem and obviate the risk of computerisation of General Practice being seen as a cause of patient harm.
Ideally all this could be handled in the form of a range of Industry Codes of Practice perhaps combined with appropriate Standards in the relevant areas. There is also a place for entities like the Australian Health Messaging Laboratory (AHML) to provide certification of conformance to agreed Standards to ensure safe inter-operation can be essentially guaranteed. Additionally the round table could consider the role of standardised approaches to interoperation between the various systems involved. Certification of GP systems may also need to be considered if progress in this area does not follow reasonably soon.
It is important for all involved to be very clear that we are only one Coroner's Case or Supreme Court decision away from compulsory application of solutions that may be neither ideal or in-expensive, so delay would be unwise. Recognition of the problem on the part of Medical Defence organisations is also likely to result in pressure to ensure safe and reliable systems are available and used.
It is also clear that well designed practice management systems can greatly assist in ensuring all important results are received (or followed up if not) and actioned appropriately once received. The issue is not if GP computing is needed or not – it clearly is. The issue is to be sure what is functional, safe and reliable and fully meets the needs of its users. I am not yet convinced the ‘market’ has sorted these issues out adequately and the patience of the GP community of users should not be too elastic.
Hopefully the area of the quality and safety of GP computing will be one that will be incorporated in the National E-Health Strategy, which I believe the new Australian Health Information Council should be developing. They should not see taking their time on this issue as an option!
David.
First there was a very lively discussion that emerged on the GP_TALK e-mail list which discussed the various issues that surround the handing of clinical results arriving into Patient Management Systems. The discussion was triggered by a question on just what the legal responsibilities were to monitor the incoming areas for arriving results from pathologists, radiologists etc and who was legally liable if an important result went astray and just what the dividing line, if any, was between the test orderer, the result provider and the result receiver / reviewer.
The interest in this topic is considerable because of previous legal liability decisions which make it clear it is the court's view that when a clinician orders an investigation which has the possibility to reveal 'clinically significant' information the practitioner has a considerable legal onus upon them to ensure they have systems in place to ensure that they will, within a reasonable period of time, note and act on the results as they are received.
Second there have been a number of concerns expressed by a range of authorities considering what expectations should be held for the functionality, reliability, usability and clinical safety of software designed to be used by clinicians. This is seen as encompassing areas such as scope, currency, accuracy and reliability of clinical decision support, the aspects of the system design that facilitate safe and consistent use of the software as well as the overall functionality offered.
Third the CEO of HealthLink (Mr Tom Bowden) recently wrote a discussion paper highlighting the problems that can arise if there is not 'end to end' accountability for the entire investigation ordering cycle – covering ordering, processing, resulting and review. This paper clearly recognises the need for substantive co-operation between clinical messaging providers and developers of clinician systems to ensure highly effective integration and the practical removal of any risk of important information 'falling between the cracks'.
This paper – in its current version – can be found at the following URL
http://www.healthlink.net/healthlink_documents/brochure/Electronic%20messaging%20safety%20Issues%20-%20HealthLink%20viewpoint.pdf
Fourth, as best I can tell, NEHTA has articulated no policies or plans in the area of clinical software quality and safety to date, and has not been sponsoring any publicly announced programs in the area.
Fifth, if discussions in GP e-mail forums are to believed, there are some real issues regarding to responsiveness of providers of GP software to both functional gaps and ‘bugs’.
Lastly, to date, while there has been medical software industry contribution work to support the health information Standards development process, there have been limited real outcomes in terms of data portability and interoperation between GP applications. We lack any Australian Standards for patient data portability, for medical software quality and for the quality of functionality and decision support provided.
None of these issues are exactly new, but their emergence does serve to highlight that there are considerable risks associated with having an e-health environment which is fragmented in terms of how quality and safety issues are addressed.
What is needed is really quite clear – a clear division of labour as to who is responsible for which part of the information chain and accountability on the part of all to deliver as fail-safe and reliable solutions as is humanly possible.
It seems to me there needs to be some form of national round table convened which brings together the patient management system developers, the messaging providers, result providers, expert clinicians and health informaticians to develop a framework under which responsibility for each part of the chain can be identified and those involved can then work to develop approaches and solutions which will solve the problem and obviate the risk of computerisation of General Practice being seen as a cause of patient harm.
Ideally all this could be handled in the form of a range of Industry Codes of Practice perhaps combined with appropriate Standards in the relevant areas. There is also a place for entities like the Australian Health Messaging Laboratory (AHML) to provide certification of conformance to agreed Standards to ensure safe inter-operation can be essentially guaranteed. Additionally the round table could consider the role of standardised approaches to interoperation between the various systems involved. Certification of GP systems may also need to be considered if progress in this area does not follow reasonably soon.
It is important for all involved to be very clear that we are only one Coroner's Case or Supreme Court decision away from compulsory application of solutions that may be neither ideal or in-expensive, so delay would be unwise. Recognition of the problem on the part of Medical Defence organisations is also likely to result in pressure to ensure safe and reliable systems are available and used.
It is also clear that well designed practice management systems can greatly assist in ensuring all important results are received (or followed up if not) and actioned appropriately once received. The issue is not if GP computing is needed or not – it clearly is. The issue is to be sure what is functional, safe and reliable and fully meets the needs of its users. I am not yet convinced the ‘market’ has sorted these issues out adequately and the patience of the GP community of users should not be too elastic.
Hopefully the area of the quality and safety of GP computing will be one that will be incorporated in the National E-Health Strategy, which I believe the new Australian Health Information Council should be developing. They should not see taking their time on this issue as an option!
David.
Sunday, March 18, 2007
An Open Letter to Minister Tony Abbott.
The following is a letter I e-mailed to Minister Tony Abbott a little over a week ago. In the covering note I pointed out I would like a response and that I planned to publish the letter on this site after a week or two.
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An Open Letter to Minister Tony Abbott.
11th March 2007
The Hon Tony Abbott MP
Leader of the House; Minister for Health and Ageing.
PO Box 6022
House of Representatives
Parliament House
Canberra ACT 2600
Dear Mr Abbott,
The Australian health system is not as safe, as efficient or as cost effective as it could and should be.
A major, but not the only reason for this is that the health sector is not using proven Information and Communication Technology effectively in order to get the benefits which have been received by virtually all other sectors of the Australian economy.
I believe this is a major policy failure of the present Government and will have electoral consequences unless addressed promptly with a coherent, inclusive and properly funded National Health IT Strategy in conjunction with an appropriate Business Plan and Implementation Strategy. Neither NEHTA nor the newly re-formed Australian Health Information Council appear to be cognisant of and focussed upon the excess costs and suffering inaction is causing. Action is required promptly.
There will be electoral consequences due to the public perceptions of wastage of many dollars on the current strategy, the lack of transparency in the evaluation and reporting of what has been achieved to date, the recognition we are slipping well behind other countries (e.g. the UK, Canada and the Netherlands) and the unacceptable number of otherwise avoidable deaths and injuries due to unsafe and inadequate systems.
The net benefits of successful implementation of such a plan would conservatively be at least five percent of national health expenditure ($4 Billion per annum), if overseas research from the US, the UK and Canada are any guide.
I have developed an internet web-log containing over 140 articles on this topic over the last 12 months and I have exposed my thinking to public criticism and review. I have found that the 200 plus expert readers are typically very supportive of my suggestions in the Health IT domain.
I would be pleased to have your officials browse my web-log for a well considered and developed set of ideas and approaches on what is needed to recruit the benefits and to move Australia forward in this very important area.
The web-log can be viewed at http://www.aushealthit.blogspot.com/ .
Yours truly,
- Signed -
(Dr) David More MB, PhD, FACHI.
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As of the time of posting no response has been received from the minister
David.
-----------
An Open Letter to Minister Tony Abbott.
11th March 2007
The Hon Tony Abbott MP
Leader of the House; Minister for Health and Ageing.
PO Box 6022
House of Representatives
Parliament House
Canberra ACT 2600
Dear Mr Abbott,
The Australian health system is not as safe, as efficient or as cost effective as it could and should be.
A major, but not the only reason for this is that the health sector is not using proven Information and Communication Technology effectively in order to get the benefits which have been received by virtually all other sectors of the Australian economy.
I believe this is a major policy failure of the present Government and will have electoral consequences unless addressed promptly with a coherent, inclusive and properly funded National Health IT Strategy in conjunction with an appropriate Business Plan and Implementation Strategy. Neither NEHTA nor the newly re-formed Australian Health Information Council appear to be cognisant of and focussed upon the excess costs and suffering inaction is causing. Action is required promptly.
There will be electoral consequences due to the public perceptions of wastage of many dollars on the current strategy, the lack of transparency in the evaluation and reporting of what has been achieved to date, the recognition we are slipping well behind other countries (e.g. the UK, Canada and the Netherlands) and the unacceptable number of otherwise avoidable deaths and injuries due to unsafe and inadequate systems.
The net benefits of successful implementation of such a plan would conservatively be at least five percent of national health expenditure ($4 Billion per annum), if overseas research from the US, the UK and Canada are any guide.
I have developed an internet web-log containing over 140 articles on this topic over the last 12 months and I have exposed my thinking to public criticism and review. I have found that the 200 plus expert readers are typically very supportive of my suggestions in the Health IT domain.
I would be pleased to have your officials browse my web-log for a well considered and developed set of ideas and approaches on what is needed to recruit the benefits and to move Australia forward in this very important area.
The web-log can be viewed at http://www.aushealthit.blogspot.com/ .
Yours truly,
- Signed -
(Dr) David More MB, PhD, FACHI.
----------
As of the time of posting no response has been received from the minister
David.
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