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Many thanks to all who have dropped in - and especially to those who have commented and added to the conversation!
David.
I was sent this link today.
The session is from a Cochrane Foundation Colloquium that happened a week or so ago in Colorado.
The session title was as follows:
Beyond bounds: care and research in a mobile world
The presenter is:
Ida Sim, University of California, San Francisco
It lasts about 20 mins and is well worth a watch. If the area of Evidence Based Medicine is of interest you can watch a lot of other presentations here:
Enjoy!
David.
We have had this special event announced yesterday.
28 October 2010
The nation’s leading health experts, consumer groups and information technology specialists will come together to discuss the technological revolution in the delivery of health care at the E-Health Conference.
Minister for Health and Ageing Nicola Roxon said the e-health conference to be held in Melbourne at the end of November is an important opportunity for stakeholders to discuss how Electronic health and telehealth will drive the delivery of health care into the future.
“The Gillard Government is investing almost $470 million to introduce e-health across the health system – including the introduction of personally controlled electronic health records to be rolled out from July 2012,” said Ms Roxon.
“This investment will build upon the $392 million committed to modernise the health system by providing Medicare rebates for online consultations across a range of specialties for the first time.
“This investment will help people who live in rural and regional Australia to get the health care they need. It will save patients the time and expense of travelling long distances to see medical specialists, and will help them to see the right specialist sooner.
“These reforms will derive clear benefits from the rollout of the National Broadband Network and will enable better and safer care for patients that is more responsive to their needs.
“That’s why I want to get the stakeholders together so that we can get maximum value out of the Government’s investment and ensure that there is detailed discussion about the implementation plans leading into broader community consultation.
“We have already selected three lead implementation sites – in Brisbane, East Melbourne and the Hunter Valley.
The conference – a landmark forum – will provide an important opportunity for cross-sector collaboration and discussion around the design, implementation and vision for future capabilities of the system.
Representatives from governments, industry, private and public sector health care organisations, clinicians and consumer groups will discuss how this innovative system will work into the future.
“The Gillard Government is getting on with the business of delivering improved health services to the community. E-health will help prevent medication errors that cause an estimated 190,000 hospital admissions each year, costing $660 million, and the 8% of medical errors caused by inadequate patient information.
Minister Roxon and Senator Stephen Conroy, Minister for Broadband, Communications and the Digital Economy, will be speaking at the event.
The E-Health Summit will take place on the 30 November and 1 December at the Melbourne Convention Exhibition Centre.
For more information regarding the E-Health Conference, please contact Ms Sharon McCarter at the Department of Health and Ageing on 02 6289 3558
Press release is found here:
What is missing from all this is the link to a series of strategic and technical discussion papers to be discussed at the Summit.
The whole process is utterly back to front as well as DoHA is having this gabfest after the release of tenders for components of the PCEHR. So how exactly is the Summit going to affect what we wind up with.
The phrase ‘window dressing’ pops into mind.
Last comment - remember we have all been here before with Summits and National E-Health Strategies developed by the Boston Consulting Group in 2004 and Deloittes in 2008. Where has all that actually got us?
If some detailed informative plans, budgets and resourcing is not provided well ahead of the Summit you can be assured it will be a joke! Any serious effort at consultation and discussion would have all this mapped out and delivered with the announcement I believe.
I look forward to the discussion documents!
David.
The following appeared late last week.
THE National E-Health Transition Authority has snubbed government guidelines designed to boost local participation in its first major tender.
NEHTA cited its controversial status as a private corporation owned jointly by the federal and state governments.
The Health Department refused last week to reveal how much NEHTA spent on travel in the past financial year, saying the taxpayer-funded body was not required to report such information under its funding agreement.
Over the past year, Liberal senators Sue Boyce and Concetta Fierravanti-Wells have been pursuing details of NEHTA's spending and accountability to parliament, and Senator Boyce has expressed frustration that its representatives cannot be compelled to appear before Senate estimate hearings and inquiries.
Now NEHTA has told bidders on the large National Authentication Service for Health contract that it does not need to comply with normal agency purchasing rules.
"NEHTA is a company limited by guarantee and as such falls outside of the scope of the Australian government procurement guidelines," it said.
Under Innovation Minister Kim Carr's $19 million Australian Industry Participation program launched last year, firms bidding for federal government work must lodge a plan showing they have considered options to include local firms in their tenders.
Small to medium-size businesses now have a backer in their corner, with Mr Carr appointing Don Easter as his office's IT supplier advocate in June.
Mr Easter said he queried NEHTA's stance when the NASH tender was released.
"I wrote to them in my role as advocate, saying you have to include provisions for an industry participation plan, and they came back to me saying 'no we don't'," he said.
"That is the case. I checked with the Health Department and the AIP requirements only apply to government agencies. However, they did say they were committed to the principles of open tenders, fairness and equity."
Mr Easter said industry plans were a "light touch" approach intended to ensure opportunities for local firms were routinely considered in tender responses.
" I know a bit about authentication and there are many people in the marketplace who do this type of thing now," he said. "What's interesting is why it took NEHTA so long to put it to tender. . .
More here:
I wonder how long it is going to take the Government and Opposition to recognise they have an out of control train here that is happily spending public funds with no real oversight.
It would seem to me there is very considerable political risk for Government especially in all this. Consider the scenario that we are a year further down the track from the present. The HI Service Implementation has gone less than perfectly - with all sorts of predicable barriers to smooth implementation arising as workflow implications, costs to software providers and so on begin to bite. Combine this with a NEHTA sponsored public education program that is raising awareness but where the public is failing to see all that much actual outcome.
It is now 18 months or so since the inception of the service, with NASH and the PCEHR still to actually happen, and with the exception of the pilots not much is being delivered.
In that circumstance, which has to have at least a 50% chance of being reality, the Opposition will be able to have a picnic at Senate Estimates Committees and in the political lead up to the next election.
NEHTA would be much smarter to proactively and honestly work with Medicare to get real plans, budgets, resource requirements and so on out there as cover and risk mitigation. And they also should turn up at estimates to provide a clear account - unfiltered by DoHA - as to what is really going on, and what issues they face - so they are not torn apart in a political backlash when the issues are recognised long after the event and blame has to be apportioned.
Openness works well to protect from the damage of surprise revelations - especially in the political scene.
A little proper prophylactic disclosure could do great things for NEHTA’s reputation to say nothing of the e-Health Project in total.
I suspect the inevitable backlash, when it comes if this risk is not managed well, will just sweep both the good and the bad of NEHTA away.
David.
The following popped up late yesterday.
By Josh Taylor, ZDNet.com.au on October 26th, 2010
No vendor with half a brain would sign a developer contract with Medicare to work on software as part of the government's e-health agenda, National E-Health Transition Authority (NEHTA) national clinical lead Dr Mukesh Haikerwal said this morning.
When asked at an Australian Information Industry Association e-health forum in Sydney this morning why just 14 out of the 80 software developers who had a developer's kit had signed a developer's agreement with Medicare, Haikerwal said he wouldn't hide from the problem.
"I think the contracts — and this is on the public record and I've said this to the people responsible — the contracts the vendors have been asked to sign are not the sort ... that anyone with half a brain would want to sign," he said.
"If you're going to be fair dinkum about getting the vendor involved in this space you've got to make a contract that they can adhere to. [A contract] that is reasonable and is deliverable and you can't put belts and braces on them and hold them back and tie both hands behind their back and then say, now you've got to play in this space," he added.
"So I wholeheartedly agree there are problems with the contracts. And we've got to make it better. My job is to make it better. If they don't like me saying it, they can sack me that's fine. I'm very happy to go somewhere else."
Despite teething problems with getting developers onboard, the benefits e-health offered would be immediate for clinicians, Haikerwal said. In his own clinic he identified that secure messaging offered by e-health could potentially save up to $30,000 a year in the cost of scanning and sending patient documents manually.
Haikerwal admitted that delivering personally controlled e-health records in just two years was a big ask, and said that NEHTA needed help from the IT industry to meet its goals.
More worrying material here from a thorough coverage.
http://www.zdnet.com.au/nehta-lead-attacks-e-health-contracts-339306849.htm
I really don’t think there is much to add here. We have the NEHTA sponsored blogger spinning away saying how good all this is - but, as quoted, I find it very hard to see there is much good news for NEHTA and Medicare here.
My view, if their Clinical Lead finds it necessary to speak out like this there is ‘trouble at mill’!
David.
I noticed this the other day.
Open-source system lets health care organizations exchange records securely and efficiently
Until recently, there wasn’t an easy way for federal agencies to securely and efficiently exchange health care information with one another or other organizations.
But a standards-based, open-source approach orchestrated by the Health and Human Services Department's Office of the National Coordinator for Health IT promises to do just that via the Connect program.
The Connect program supplies free software that government agencies and private-sector health care providers can use to exchange patient information.
…..
To overcome the obstacles to sharing medical information, the Federal Health Architecture at the Office of the National Coordinator for Health IT began developing the Connect program in 2007.
“The goal of Connect was not simply to define standards for exchanging medical information but to create the actual software necessary for federal agencies to start sharing that information securely and efficiently,” said Dr. Douglas Fridsma. Fridsma is director of ONC's Office of Interoperability and Standards and interim director of FHA and Connect.
The Connect program is an unprecedented collaboration that combines the efforts of more than 20 federal agencies to create a single platform for exchanging health information. The aim is save each federal agency the time, cost and resources needed to create a compliant system by fielding a single system that all agencies could immediately implement. Using a single system also eliminates the necessity of integrating different systems and testing them separately.
…..
It consists of three primary components.
Full article here:
http://gcn.com/articles/2010/10/18/gcn-award-hhs-connect.aspx
It seems to me we should be having a close look at what has been developed here, as having been implemented in a number of locations, this is actually working software that just might be useful and which I believe can be freely accessed.
Just a thought!
David.
Sorry to cross over into the financial domain but this will probably be an important distractor for Mr David Gonski, AC, present Chairman of the ASX and possible future member of the merged board, as far as his focus on NEHTA is concerned.
Here is the report from yesterday:
October 25, 2010
Update The Australian Securities Exchange and Singapore's stock exchange (SGX) have agreed on the first major consolidation of exchanges in the Asia-Pacific, in a takeover valuing the ASX at $8.4 billion.
- The combined bourse will be Asia's second largest
- SGX chief will be CEO, ASX chairman to be deputy chair
- Merger unanimously recommended by both boards
- The ACCC effectively green lights the deal
- Analysts consider the price fair value
The deal values the ASX at $48 per share - amounting to a premium of 37.3 per cent to the $34.96 price the ASX's shares traded at on Friday before news of talks broke.
ASX shares leapt on the resumption of trade today, surging as much as 26 per cent, to $43.89, before closing up $6.79 for the day, or 19 per cent, at $41.75. Shares of SGX, though, lost 5.8 per cent after its trade resume, easing to $S8.99 before clawing back some of its loss.
In the scheme of arrangement offer, SGX will pay a combination of $22.00 in cash plus 3.473 of its own shares for each ASX share.
"The offer is not near ASX's all-time high, but it is certainly great," said Mark Daniels, head of Australian equities at Aberdeen Asset Management, which owns ASX shares.
Regulator's green light
The deal will need approval from the Foreign Investment Review Board, which could be nervous about the deal as SGX is 23 per cent owned by the Financial Sector Development Fund, which is controlled by Singapore's central bank.
"There's quite a few regulatory hurdles for this, which is why the shares are trading below the notional value of the offer,'' said Tom Elliott, managing director, MM&E Capital.
''There's FIRB and parliament has to actually approve it. You've got a strange parliament, you've got the rural independents. Nothing would surprise me. It just means this is going to take a while, so there's that uncertainty," Mr Elliott. "(The price) seems pretty fair.''
However, the competition regulator effectively gave the SGX a green light earlier today to pursue the takeover, saying it did not see any major concerns.
The combined market capitalisation of the two groups was about $12.5 billion at October 22. Assets under management at the two exchanges total some $US2.3 trillion ($2.34 trillion), according to a joint release by the two companies.
Much more here:
http://www.smh.com.au/business/singapore-in-84b-asx-takeover-20101025-16zy3.html
However today it now becomes clear this is not going to happen easily.
October 26, 2010 - 3:23PM
Federal Treasurer Wayne Swan has warned that Singapore Exchange's $8.4 billion takeover of the Australian Securities Exchange still has a number of regulatory hurdles to clear before going ahead, as the Greens and the Coalition voice concerns over the deal.
Mr Swan told parliament today the deal would be scrutinised by the government's Foreign Investment Review Board, which would seek advice from the Australian Securities and Investment Commission and the Reserve Bank of Australia.
Parliament would also need to approve a new regulation allowing a single shareholder to own more than 15 per cent of the ASX, he said.
"The regulatory process ensures that decisions are always taken in Australia's national interest and that the market integrity of the ASX will be preserved," Mr Swan said.
A proposal of this type would be subject to ‘‘extensive regulatory considerations’’ under Australia’s foreign investment policy and the Corporations Act.
"Australia's financial system has performed better than any other during the global financial crisis and of course the ASX is an important part of our financial system's architecture.
"So we will continue to consider all transactions with the objective of carefully and methodically building Australia's reputation as a financial services hub and, as always, we will do this in the national interest."
All the details here:
http://www.smh.com.au/business/asx-takeover-faces-regulatory-hurdles-swan-20101026-171la.html
Given Mr Gonski’s well-known political and management skills I think we can be sure what is going to be keeping him flat out till Christmas at least - unless the politicians just abort it suddenly! (NEHTA hardly compares with an $8.4 billion merger that will need some considerable skill to bring off!)
I think a new interim chair might make sense till this is resolved one way or the other. No offence Mr Gonski but I think you have more than enough on your plate with the ASX!
David.
I spotted this a day or so ago.
October 20, 2010
THE trouble-plagued myki project has hit another snag, with the expected cost of training newsagents and 7-11 stores to sell and top up the smartcards costing $1.4 million more than originally contracted.
Despite the increased cost, the Brumby government has still not revealed when more than 700 newsagents and retailers contracted to sell and top up myki cards will begin sales.
It comes as a new staff list for the government agency overseeing myki's installation shows employee numbers growing to 161 people. This includes 13 community liaison officers and five media officers.
The government's Transport Ticketing Authority is charged with supervising the creation and rollout of myki, and managing the existing Metcard contract.
Since 2007 - the year myki was meant to be fully rolled out - the Transport Ticketing Authority has grown from just 74 staff. Kamco, the firm being paid to create and install myki for the government, today has 73 full-time staff, and 120 subcontractors.
The government's staff numbers do not include scores of ''myki mates'', employed on casual contracts as part of a $5 million government push to promote myki at rail stations and tram stops.
Transport Ticketing Authority chief executive Bernie Carolan said yesterday he would prefer that the number of people employed by his agency was shrinking, not growing. ''[But] we have got a broad range of responsibilities,'' he said.
…..
Contracts released to opposition transport spokesman Terry Mulder under freedom of information show the cost of training staff at newsagents and retail stores to sell myki will be $1.4 million more than expected when the contract to roll out myki was signed in 2005.
A source within Kamco said the government had constantly changed the specifications of what it wanted, leading to increased costs.
Adrian Darwent, a Transport Ticketing Authority spokesman, said the increase in payments to Kamco was because the number of staff needed to be trained ''could only be negotiated once the size and scope of the retail network was determined''.
Full article is here:
http://www.theage.com.au/victoria/myki-faces-expensive-new-hurdle-20101019-16sk6.html
What this article raises is the whole issue of how major technology projects can underscope - often badly - the costs of technology implementation and training.
Apply this to the HI Service, NASH and PCEHR and it rapidly becomes clear that there are real risks in underestimating the change management and training resources that will be needed to get an implementation done in reasonable time and with reasonable quality. Each of these programs will involve many people, much training and substantial workflow impact.
We can see from other government programs that these issues are often under addressed and that project outcomes can be badly compromised as a result.
If these programs are to be implemented they need to be done properly and not be associated with the time, cost and staff overruns we see described above. This will be no mean feat!
In that vein a day or so ago NEHTA advertised for Senior Project Managers - Implementations.
See here for the advertisement.
http://www.nehta.gov.au/careers/729-senior-project-manager-implementations
A read through this will make you quickly realise how difficult these jobs will be and what super-human resources and backup will be needed for success.
I have to say I am by no means sure NEHTA could afford the capability profile of people who could deliver these roles. We shall see.
This looks like the sort of work that should be undertaken by a very well resourced ‘project office’ and not just one or two heavy hitters to me!
David.
