My Final Submission to the BCG Review of NEHTA

First thanks to those who made comments on the initial draft.

Here is the final version of the Executive Summary.

Executive Summary

E-Health in Australia is rapidly becoming a national disgrace and the opportunity cost of not addressing it in terms of both money and lives is rising relentlessly.

The following offers an expert, independent view of NEHTA’s performance to date and recommends two key steps to remedy the currently disastrous situation.

These are:

Urgently the governance of NEHTA needs to change. The Board needs to have 3-4 representative E-Health Experts (from ACHI, MSIA, Industry etc ) and one or two independent experts added with the Jurisdictional representation dropped to 2-3 members. The Board also needs a highly qualified technical and a highly qualified clinical advisory committee with real influence and teeth. Note: The Australian Health Information Council (AHIC) – which should also have broad stakeholder input - is the right entity to ensure NEHTA stays focussed on delivery in the context of an AHIC managed strategy which I recommend below.

Longer term – six months – A consultative, inclusive, national E-Health Strategy, Business Case and Implementation Plan must be developed. This will then need to be reviewed and properly resourced and funded – managing the state / Commonwealth divides etc. NEHTA should then be managed by the governance approach recommended in that strategy and take its priorities from there as well.

The strategy needs to be developed in a open, inclusive, pragmatic and realistic way – recognising local needs, understanding the impact on all stakeholders and allowing all those who need to provide input to do so.

I must point out that I do not, in any way, diminish the complexity of what is needed to get things back on the rails, neither do I diminish the importance of it being done properly.

I also believe NEHTA, in some appropriate form, has a significant and important role (indeed critical role) in assisting moving E-Health forward. However to play that role it requires a fundamental change of attitude as to the levels of transparency and consultation it provides for all stakeholders. The entire organisation needs to become much more outwardly focussed and to have a much broader representation internally of clinical and health sector skills.

I also do not believe the present senior management are sufficiently aware of the cultural ‘modus operandi’ of the health sector to be able to operate within the sector effectively and that they need to put in a concerted effort to address that deficiency.

Australia set out on the E-Health Journey in 1997 with a report developed by a House of Representatives Committee but, for a range of reasons, progress has been much less than might have been hoped for since. It is vital this changes.

We need a new plan and direction, learning the lessons of both overseas and local difficulties and successes. Once this is developed and agreed some hope and certainty may return to the E-Health Domain in Australia.

The following three URLs provide a very high level summary of the strategic priorities and issues I see as being worthwhile to pursue over the next two to three years.

http://aushealthit.blogspot.com/2006/03/australian-e-health-strategy-why-what.html

http://aushealthit.blogspot.com/2006/06/australian-e-health-strategy-outline.html

http://aushealthit.blogspot.com/2007/07/why-is-state-hospital-health-it-in-such.html

I may not have it exactly right, but I am sure I am more right than the present strategic vacuum!

While this is being done NEHTA can see how far it can move forward on its much more long term agenda, should that be assessed as reasonable following the present review.

Lastly, it needs to be pointed out that I have had early access to the information gathered from the Health Information Society of Australia’s survey of the views of the membership to NEHTA and its performance. Review of this data has confirmed for me the fact that the views I have expressed regarding NEHTA over the last twelve months are very much mainstream and that they must be addressed. I strongly recommend a close review of the final output of this HISA work by the BCG.

It really is hard to overstate just how important proper deployment of E-Health in Australia is and just how badly it has been handled to date.

The bottom line is that what NEHTA is trying to do is very badly needed, but the way they are going about it is deeply flawed in my view and the direction needs serious modification.

(I look forward to discussing the contents of this submission with BCG. I can be contacted via my blog by e-mail)

----- End Executive Summary

The complete 12 page document can be downloaded from the following link.

It is interesting that over the last week I have seen drafts from a number of organisations that are also planning to make a submission to the BCG. It would be fair to say that there is a very large degree of similarity with my submission in terms of the sentiments expressed, but it is interesting to see the different emphasis that is put on different concerns. I think it is also fair to say that none of the drafts I have seen have been at all supportive of preservation of the status quo.

The final outcome of this review will be interesting indeed, and will be a considerable test of the influence carefully considered views can have on the shape of public policy.

David.

Useful and Interesting Health IT Links from the Last Week – 29/07/2007

Again, in the last week, I have come across a few reports and news items which are worth passing on. This week it seems to be, at least in part, to be follow-ups of last week’s finds.

These include first:

http://www.theage.com.au/news/national/medicare-claim-system-far-from-easy/2007/07/25/1185339079951.html

Medicare claim system far from easy

Annabel Stafford, Canberra

July 26, 2007

AN EFTPOS-STYLE system to allow patients to claim their Medicare rebate in the doctor's surgery — which has been widely spruiked by the Government — is facing a big hurdle just months from the election.

Doctors have threatened not to co-operate with the system unless the Government pays them for every Medicare rebate they process on behalf of patients.

The so-called Medicare Easyclaim system is likely to be popular with voters because it means they will no longer have to make a separate trip to the Medicare office to claim a Medicare rebate.

But the Government is being made to pay for introducing it, with the banks — and doctors — demanding a payment for administering the scheme.

The Age believes that doctors want about $1 per transaction.

In a speech at the National Press Club yesterday, AMA president Rosanna Capolingua said the system as it stood was not efficient enough — transactions had taken practices four minutes per patient — and its introduction should be delayed. And the doctors should be paid for processing claims. "While the objectives of Easyclaim for patients are worthy, the bottom line is that it will save the Government huge dollars in the scaling back of Medicare offices and the processing of claims," she said.

…..( see the URL above for full article)

This is a great example of how not to undertake implementation in the health sector. In this case the Government is trying to save itself huge sums in terms of staff and office space by moving Medicare claims to the individual practices. Only problem is that this inevitably involves extra work for the doctor’s staff at best and the doctors themselves at worst. Someone has to pay for the extra work and you can bet that, unless some sensible arrangement is made, the whole project will come to a sticky end.

The banks have done well and increased their profits markedly having all their customers do all the data entry to manage their finances and we have been happy to do it because it makes banking more convenient. There is nothing in it for doctors and their staff to do this to improve the Government’s bottom line. This is another example of where a payer and the patient gets most of the benefits and it is the doctor and their staff that have more work to do.

I have no idea what the right level of payment is likely to be but I know that banks are getting between $0.20 and $0.50 per transaction processed. Given manual over the counter processing is known to cost some number of dollars for the Government, which will now be avoided, you can bet the AMA will not take this lying down. I await, with interest, the next move. There is no doubt a sensible compromise is possible and this should have been worked out long before this.

Of course there is the view that all this is a medical rip off..see here for the differing view:

http://www.theage.com.au/news/opinion/doctor-heal-thyself/2007/07/28/1185339314714.html

Doctor, heal thyself

Jason Koutsoukis

July 29, 2007

Apart from more money in doctors' pockets, the AMA doesn't know what it wants. And we pay the price.

..... (see the rest at the URL above)

Second we have:

http://www.boston.com/business/technology/articles/2007/07/22/chips_high_tech_aids_or_tracking_tools_1185077501/

Chips: High tech aids or tracking tools?

By Todd Lewan, AP National Writer | July 22, 2007

CityWatcher.com, a provider of surveillance equipment, attracted little notice itself -- until a year ago, when two of its employees had glass-encapsulated microchips with miniature antennas embedded in their forearms.

The "chipping" of two workers with RFIDs -- radio frequency identification tags as long as two grains of rice, as thick as a toothpick -- was merely a way of restricting access to vaults that held sensitive data and images for police departments, a layer of security beyond key cards and clearance codes, the company said.

"To protect high-end secure data, you use more sophisticated techniques," Sean Darks, chief executive of the Cincinnati-based company, said. He compared chip implants to retina scans or fingerprinting. "There's a reader outside the door; you walk up to the reader, put your arm under it, and it opens the door."

Innocuous? Maybe.

But the news that Americans had, for the first time, been injected with electronic identifiers to perform their jobs fired up a debate over the proliferation of ever-more-precise tracking technologies and their ability to erode privacy in the digital age.

To some, the microchip was a wondrous invention -- a high-tech helper that could increase security at nuclear plants and military bases, help authorities identify wandering Alzheimer's patients, allow consumers to buy their groceries, literally, with the wave of a chipped hand.

To others, the notion of tagging people was Orwellian, a departure from centuries of history and tradition in which people had the right to go and do as they pleased, without being tracked, unless they were harming someone else.

Chipping, these critics said, might start with Alzheimer's patients or Army Rangers, but would eventually be suggested for convicts, then parolees, then sex offenders, then illegal aliens -- until one day, a majority of Americans, falling into one category or another, would find themselves electronically tagged.

The concept of making all things traceable isn't alien to Americans.

Thirty years ago, the first electronic tags were fixed to the ears of cattle, to permit ranchers to track a herd's reproductive and eating habits. In the 1990s, millions of chips were implanted in livestock, fish, dogs, cats, even racehorses.

Microchips are now fixed to car windshields as toll-paying devices, on "contactless" payment cards (Chase's "Blink," or MasterCard's "PayPass"). They're embedded in Michelin tires, library books, passports, work uniforms, luggage, and, unbeknownst to many consumers, on a host of individual items, from Hewlett Packard printers to Sanyo TVs, at Wal-Mart and Best Buy.

But CityWatcher.com employees weren't appliances or pets: They were people made scannable.

"It was scary that a government contractor that specialized in putting surveillance cameras on city streets was the first to incorporate this technology in the workplace," says Liz McIntyre, co-author of "Spychips: How Major Corporations and Government Plan to Track Your Every Move with RFID."

…..( see the URL above for full article)

This is an interesting long one from the Boston Globe that goes on to explore a range of aspects of implanted RFID in humans and just where all this may be heading. Well worth a browse.

Third we have:

http://www.sacbee.com/101/story/286594.html

Medical records, advice just a few clicks away

By Danielle McNamara - Bee Staff Writer

Published 12:00 am PDT Monday, July 23, 2007

During her cancer treatment, Doris Taylor made sure to record medical appointments on a hanging calendar in her house. The problem: She never read it.

"I've missed appointments," Taylor said. "I completely forgot about them."

Since then, Taylor discovered the convenience of managing her health care online. With so many doctor, lab and procedure appointments, it was hard for her to keep everything organized.

"Before there'd be a lot of missed phone calls if I forgot something my doctor told me," the 69-year-old said. "Now I just send an e-mail and they get right back to me."

Taylor uses Kaiser Permanente's Health Connect to track appointments and prescriptions.

She said this new access makes her relationships with doctors more comfortable.

Today consumers are doing everything from buying car insurance to sending party invitations with a few clicks on their home computers. National surveys show that patients embrace the idea of e-mailing doctors and electronically scheduling appointments and refilling prescriptions.

Following society's growing need for instant results, more health care providers are starting to offer online access to their patients -- and the number of enrollees continues to climb. Patient and physician access to medical histories via computer provides safer and better quality care than paper files, experts say.

Kaiser Permanente and other regional health networks that have provided online systems are rolling out more user-friendly and secure Web sites.

…..( see the URL above for full article)

Again a great review of where things are heading from the Sacramento Bee. The rate of enrolment is clearly rising and benefits are flowing for all concerned. Clearly the degree of integration of the Kaiser Permanente’s various delivery arms makes this easier than it may be in Australia – but is seems to me it’s the sort of outcome, for patients and their carers, we should aspire to.

Fourth we have:

http://www.philly.com/inquirer/business/20070722_Hospitals_Going_High-tech.html

Hospitals Going High-tech

By Stacey Burling

Inquirer Staff Writer

If you haven't been in a hospital for a few years, you might be surprised at how technology aimed at making your stay safer and more enjoyable is emerging in this notoriously paperbound industry.

Your doctor may wheel a computer into your room during an exam.

Your nurse may scan the bar code on your ID bracelet before giving you a pill. If you face a long wait for a procedure, a hospital employee may give you a pager much like the ones those perpetually busy chain restaurants hand out. Your preemie may send you an e-mail.

At Bryn Mawr Hospital's new outpatient building in Newtown Square, patients can check themselves in using tablet computers. At the hospital's emergency department, RFID chips embedded in plastic tags tell staff where patients are, when they get an EKG, and when the doctor first sees them.

Doylestown Hospital's emergency department can now scan for information stored on RFID microchips embedded beneath the skin of some patients; the numbers coded in the tiny capsules link to medical records on the Internet.

Cameras in Virtua Health System's four emergency departments allow neurologists to examine patients with stroke symptoms remotely.

Patients at St. Mary Medical Center can order food by phone from a menu - for delivery whenever they want.

These changes in approach come in response to pressure to reduce errors, use space and employees more efficiently, and give savvy patients reasons to choose a particular hospital over a competitor.

…..( see the URL above for full article)

This is an amazing collection of the varying aspects of e-Health that are being implemented in different hospitals around Philadelphia and the impact it is having. Well worth a quick scan.

Fifth we have:

http://www.startribune.com/462/story/1311484.html

Park Nicollet gets tough on snooping in patient files

100 employees have been suspended and the clinic warned of "zero tolerance" for even a well-meaning look into electronic records of relatives or friends.

By Maura Lerner, Star Tribune

Last update: July 19, 2007 – 11:45 AM

More than 100 Park Nicollet Clinic employees have been suspended this year for violating federal laws on patient privacy -- mostly by tapping into electronic records of relatives or friends, according to clinic officials.

This week, the clinic notified its 8,300 employees about the suspensions as a reminder of what it calls its "zero tolerance policy" on confidentiality. Already, twice as many employees have been disciplined for privacy violations in 2007 than in all of 2006, officials say. They were suspended without pay for three days.

The problem has surfaced in hospitals and clinics across the nation as they have switched to electronic records. While new technology has made it easier for employees to snoop where they don't belong, experts say, it has also made it easier to catch them.

"Anyone that has anything to do with patient care, from scheduling appointments to actually performing patient care, has access to the medical record," said Susan Zwaschka, Park Nicollet's general counsel, who wrote the e-mail to the clinic staff. "That's why we take it so seriously."

In many cases, employees have been tempted to peek at charts of neighbors or family members -- a case of "old habits die hard," said Jan Rabbers, a Minnesota Nurses Association spokeswoman.

…..( see the URL above for full article)

Another example of how it is important to ensure there are both procedures, monitoring and sanctions in place to ensure electronic records are not abused. To achieve high levels of compliance and to ensure patient trust frequent policy reminders are crucial.

Lastly we have:

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=511249

An Analysis of Leading Congressional Health Care Bills, 2005-2007: Part II, Quality and Efficiency

July 26, 2007 | Volume 64

Authors:

Karen Davis, Sara R. Collins, and Jennifer L. Kriss

Contact:

kd@cmwf.org

Editor(s):

Martha Hostetter

Overview

The U.S. health care system will become a high performance health system only with strong leadership from the federal government in partnership with the private sector.

A prior report analyzed the likely effect on U.S. health system performance of congressional legislative proposals to extend health insurance coverage. This report addresses the major bills introduced over 2005–2007 designed to advance the quality and efficiency of the health system. The bills relate to: Medicare prescription drug coverage; Medicare payment reform; transparency; health information technology; patient safety; medical liability reform; and elimination of health disparities. Although they fall short of a comprehensive strategy for systemwide improvement, the legislative proposals potentially lay a foundation for more fundamental reforms.

…..( see the URL above for full article and graphic)

I realise this looks pretty amazingly dry. However the full Executive Summary is well worth a read as it frames nicely where the various arms of Health Reform may make a difference. The full 100 + page report can also be downloaded from the site.

All in all not a bad lot to start the week!

More next week.

David.

Update and More Amazement on the South Barwon Project!

It seems there is a political need for Minister Coonan to be a little flexible with the truth. This is something you can’t quite get away with when reporting to the Australian Stock Exchange (ASX).

Today we have the following release and have a better outline of what is planned:

ASX / MEDIA ANNOUNCEMENT

WSS e-health software in pioneering Chronic Disease Management Network Broadband Based Service Aims to Transform the Treatment of Chronic Disease

Melbourne, Victoria – 26 July 2007: Working Systems Solutions (ASX:WSS), today announced that their e-health connectivity and consumer products will be a key component of a pioneering Chronic Disease Management Network project (CDM-Net) across the Barwon region in Victoria.

The $8.7 million CDM-Net is being led by Precedence Health Care in collaboration with Barwon Health.

The Australian Government is contributing $2 million under the Clever Networks Program and the Victorian Government a further $2 million through the Department of Innovation, Industry and Regional Development, the Department of Human Services, and Multi Media Victoria.

CDM-Net involves a consortium of leading industry and health care organizations, including Barwon Health, Cisco Systems, IBM, Intel, Working Systems Solutions, Diabetes Australia Victoria and the GP Association of Geelong. Research and evaluation of CDM-Net will be carried out by Monash, Deakin and Victoria Universities with the assistance of CSIRO’s ehealth Research Centre. CDM-Net will be developed for use in the Barwon South Western Region of Victoria, reaching from Geelong to the South Australia border.

Precedence Health Care CEO, Professor Michael Georgeff said, “By helping doctors plan, track and intensively manage the care of people with diabetes, the evidence indicates that we may be able to reduce hospital admissions and other adverse events by more than 50%. CDM-Net will do this by using the Internet to connect and share information across a patient’s entire care team, including doctors, specialists, hospitals, and other care providers. It will continuously monitor health parameters of patients, such as blood glucose levels and medications, helping them to adhere to their care plans by sending them reminders and alerts.”

The Minister of Communications, Information Technology and the Arts, Senator Helen Coonan in her announcement of the Australian Government grant said, “Chronic illness requires close monitoring and ongoing management across an entire team of care professionals.

“People suffering from chronic disease need to be provided with a care plan, detailing medications, treatments, tests, and referrals tailored to their specific circumstances, and CDM-Net will facilitate that. The project will support the roll out of chronic disease management applications in urban, regional, remote and rural Australia while fostering Australian information communication technology innovation.

”Senator Coonan said a key concept behind the solution is an “open” network of services. “This allows different organisations, including private sector organisations, to ’plug in’ to the network.

“CDM-Net will be initially implemented in the Barwon South Western Region of Victoria, however it has the potential to be rolled out across other regions of Victoria and nationally,” Senator Coonan said.

WSS CEO, Mathew Cherian said, “Our e-health portfolio will contribute many of the key software infrastructure components that CDM-Net will assemble and build on.

“The underlying open connectivity, SMS reminders, secure referral messaging and workflow management have all been proven in a variety of projects using our e-switch software platform. Similarly, our shared care Electronic Medical Record (EMR) software for diabetes (betterdiabetes.com) and Mental Health (MHAGIC) are recognised as world-class solutions.

“CDM-Net is a significant project for WSS representing an opportunity to bring our proven ehealth capabilities and credentials together in a world class private-public sector joint initiative to deliver better health outcomes for consumers.”

So what is different?

1. We now have an apparently $8.7 Million project.

2. We now have a range of partners so wide they will trip over each other. There are also a good few with a substantial profit motive.

3. We have a proprietary commercial software provider doing the hard work – the openness of all this is yet to be proven if it actually exists.

4. The project almost replicates the old HealthConnect Diabetes Care trials – South Brisbane as I recall – openEHR and all that – never evaluated that I have seen.

5. The Ministerial Press Release simply did not describe what is planned.

Will all this actually work and make a difference – I doubt it – but many people will have a satisfying cash infusion.

There are many examples of such diabetes related projects overseas that have worked so it is unclear just why a trial is even necessary – but so many get some payoff if one is conducted!

This report from iHealthBeat must raise some concerns:

http://www.ihealthbeat.org/Articles/2007/7/19/Report-IT-Useful-in-Managing-Diabetes-but-Cost-is-a-Concern.aspx

July 19, 2007

Report: IT Useful in Managing Diabetes, but Cost is a Concern

Providers can use IT to help manage patients with type 2 diabetes, but costs outweigh the savings for many of the technologies, according to a new report from the Center for Information Technology Leadership, Health Data Management reports.

However, the use of electronic diabetes registries and clinical decision-support software are the exceptions, according to the report, called "The Value of Information Technology-Enabled Diabetes Management." Researchers estimate that use of diabetes registries could save $14.5 billion in health care expenditures over 10 years and that clinical decision support software could save $10.6 billion over the same period.

….. (see the rest at the iHealthBeat site)

I hope those running the trial have actually read the available evidence and it’s a bit sad Ministerial press releases do not actually explain what is going on.

Thank heavens we have the ASX to provide at least one version of the truth! Note we still have no idea if Precedence Health Care has any capability to deliver given DoHA seemed not to and this trial is hardly a test of open network services given the proprietary solution (standards compliant though it may be – or plan to be) involved.

A question – does anyone know if Presence Health Care is more than a shell company? Public information is not that easy to find – and should be given the part the Commonwealth and Vic Health are playing!

Disclaimer (Sensibly, I think, I do hold a few shares in Working Systems – may they prosper in all this for my pension fund! Sadly I don’t think it moves Australian e-Health ahead much given it has all been done before.)

Even with the extra information provided this trial has all the feel of another one of those strategically unfocused and unaligned projects from which little, if any good, will result. It could only happen in the current national e-health strategic vacuum where AHIC, DoHA and NEHTA are essentially asleep at the wheel.

Note: because this is breaking news the link to my full BCG Submission will go up next week!

David.

ps. It's amazing how some comment can suddenly cause an "under - construction" web site to develop a huge page of logos. I hope all those organisations are comfortable with that!

D.

Another Two Million Dollars Wasted!

I was alerted to this press release from the Federal Communications Minister yesterday.

http://www.minister.dcita.gov.au/media/media_releases/clever_networks_transforms_chronic_disease_management

98/07

Tuesday 24 July 2007

Clever Networks transforms chronic disease management

“The Minister for Communications, Information Technology and the Arts, Senator Helen Coonan today announced the eighth preferred applicant under the first round of the Clever Networks program.

Precedence Health Care’s Chronic Disease Management Network, CDM-Net: A Broadband Health Network for Transforming Chronic Disease Management, will use broadband to transform the management of chronic disease thanks to $2 million in funding by the Australian Government.

CDM-Net will create a network of health services for monitoring and supporting care management.

“Chronic illness requires close monitoring and ongoing management across an entire team of care professionals,” Senator Coonan said.

“People suffering from chronic disease need to be provided with a care plan, detailing medications, treatments, tests, and referrals tailored to their specific circumstances, and CDM-Net will facilitate that.”

CDM-Net will use secure broadband services to connect healthcare providers to one another and to their patients. It will assist healthcare providers create and track care plans for their chronically ill patients and support patients in their adherence to care plans through electronic reminders and alerts.

“The network will improve care coordination by sharing information on patient care across the entire care team,” Senator Coonan said.

“The project will support the roll out of chronic disease management applications in urban, regional, remote and rural Australia while fostering Australian information communication technology innovation.”

Senator Coonan said a key concept behind the solution is an ‘open’ network of services.

“This allows different organisations, including private sector organisations, to ‘plug in’ to the network.

“This will enable the provision of a range of chronic disease management services across a wide population.

“CDM-Net will be initially implemented in the Barwon South Western Region of Victoria, however it has the potential to be rolled out across other regions of Victoria and nationally,” Senator Coonan said.

Clever Networks is a $113 million Australian Government program that will see smart solutions to improve delivery of services in regional, rural and remote Australia through innovative broadband projects.

Successful projects to receive Clever Networks first round funding will include virtual healthcare, remotely accessible interactive education services, and delivery of integrated state-wide emergency services.

More information about specific projects will become available as each successful project is announced.

More information about Clever Networks is available at www.dcita.gov.au/clevernetworks

Media Contact: Senator Coonan’s office, Katherine Meier 0417 441 141”

A little more detail can be found here

http://www.zdnet.com.au/news/communications/soa/AU-2m-broadband-plan-to-help-chronically-sick-/0,130061791,339280483,00.htm

AU$2m broadband plan to help chronically sick

Jo Best, ZDNet Australia

25 July 2007 12:03 PM

The latest award has been made under the government's Clever Networks program, to create a AU$2 million broadband network for chronic disease management.

The CDM-Net network, which will be built by Precedence Health Care, will connect medical staff and their chronically ill patients, to allow them to transfer case notes and other materials securely over a broadband connection.

Patients will also be able to tap into CDM-Net and will be helped to manage their care plans through a system of electronic alerts and reminders.

The network, which can potentially be accessed by both public and private healthcare bodies, will be rolled out first in Barwon South Western region of Victoria. According to Communications Minister Helen Coonan, if the system proves successful it could be deployed across the state or even nationwide.

….. (see the rest of the Article at the URL above)

Who is Precedence Health Care one asks:

http://precedencehealthcare.com/Welcome.html

Try the URL and you will get the following:

Precedence Health Care

“Precedence Health Care aims to provide comprehensive disease management, care surveillance and wellness monitoring services for people with chronic disease and complex needs”

This website is currently under construction.

For further information, please contact:

info@precedencehealthcare.com

Obviously a substantial organisation who should be given $2.0M!

For those who wonder where this is all to happen:

“The Barwon-South Western Region is one of nine Department of Human Services regions in Victoria. It extends from Lara to the South Australian border, covering 29,637 square kilometres. The Region covers nine local government areas:

City of Greater Geelong
Borough of Queenscliffe
Surf Coast Shire
Colac-Otway Shire
Corangamite Shire
City of Warrnambool
Moyne Shire
Southern Grampians Shire
Glenelg Shire”

All I can say about all this is that it is fantastic in the real sense of that word! The proposers of this clearly have never implemented anything like this in the health sector and are never likely to in my humble opinion. They have no clue as to the issues involved and the complexities they will face I believe.

If it were possible to get anywhere in addressing the complexities of chronic disease management in a population of this size with $2.0 Million dollars worth of connectivity it would have happened long before this.

Where is the required national e-Health strategy and NEHTA to stop these silly initiatives which will almost certainly fail and waste public money! It’s amazing that a week ago the NEHTA CEO was saying the self organising health information network was not really a goes and now it gets funded.

To quote from last week’s blog:

“Further on in the article it is also claimed that a structured approach to reaching these benefits is not required. All that is needed is to connect everyone and that "The key message: don't spend time getting agreement on the data, don't spend time ensuring all the systems conform - get connected."

I have to say that when Dr Reinecke says that we need rather ‘cooler heads’ to assess all this then I am 100% with him. He makes the point, correctly that the internet has been around for a good while and working e-health has not suddenly emerged out of nothing.”

There is much more to this than meets the eye I reckon! (An imminent election may be?)

David.

Why is State Hospital Health IT in Such a Mess?

As the regular reader will know I have been on the case of the State Government Health Departments and their rather flawed approach to Health IT for some time now. Previous to yesterday’s article I had done a piece about a month ago reflecting a generalised concern for pretty much each State’s efforts. There were also a number of specific earlier articles as well. These can be found as by clicking on the following links.

The Mess that Seems to be State Health IT. – July 04, 2007

Is HealthSMART as Smart as it Claims? – June 27, 2007

The Mess in the West. – June 20, 2007,

The Children of HealthConnect – How are They Going – Part 2? – December 06, 2006

The Children of HealthConnect – How are They Going – Part 1? – December 04, 2006

The Electronic Medical Record you Have When you Don’t Have One! – September 10, 2006

Useful and Interesting Health IT Links from the Last Week – 17/06/2007 – Recent SA News.

Today we have a new article from Ben Woodhead in The Australian

http://www.australianit.news.com.au/story/0,24897,22122716-24169,00.html

Stalled hospital plan revived

Ben Woodhead | July 24, 2007

THE West Australian Health Department will try to revive a stalled $335 million public hospital software project next month, as it works to bring an end to a succession of delays.

WA's HealthTEC project is trying to overcome a succession of delays

The department has said it will call prospective system integrators and software providers to an industry briefing in August in the first sign since late last year that the project may be moving to tender.

The project, known as HealthTec, was funded by the West Australian government in 2004 and initial software implementations were scheduled for the 2006 financial year.

The Health Department failed to meet the deadline and pushed back the timetable for the release of tenders to late last year. However, tenders were not released and last December the department deferred the project for at least another six months.

A spokeswoman for the department said it was now planning to brief prospective suppliers on HealthTec in August, but she declined to provide more details of plans for the troubled initiative.

"There's going to be an industry briefing next month on the project. That's all we can say at the moment," the spokeswoman said.

Medical software developers and computer systems integrators have already been briefed on the project at least once before.

…… (read more at the URL above).

Later the article goes on to point out WA is no “Robinson Crusoe” in all this.

What is to be done? I suggest strategies are required to address the following issues:

1. The tendency of the politicians to like announcements of more nurses and new buildings rather than announcing the purchase of apparently not very patient friendly computers and technology.

2. The length of time taken to take Health IT projects from beginning to end that is typically rather longer than the political cycle.

3. The tendency of State Health Departments to come up with grand 10 year strategies that, as the sector evolves, become obsolete long before they are implemented.

4. The frequent perception on the part of many “on the ground” in state run hospitals that they are having a centralised state-wide strategy imposed on them when they had no real input into the development of that strategy

5. The disruptive nature of Health IT implementations which inevitably result in a substantial level of ‘institutional pushback’ – especially from some of the older and more senior staff members.

6. The lack of understanding, on the part of many senior health administrators, of the strongly positive business case for implementation of advanced and effective Health IT.

7. The lack of Health IT skills to the number and depth needed within the Hospitals to make Health IT implementations a relatively low risk activity.

8. The seemingly inevitable delays in procurement and other decision making with often leads to a loss of local momentum and considerable frustration.

9. The strategic uncertainties of project management and resource allocation which are part and parcel of life in the public sector.

10. The not infrequent experience of a less than totally responsive and flexible approach on the part of system vendors when being asked to fit in with local work flows and work practices.

11. The lack of any perceived direct benefit from many systems for many of those at the “coal face” leading to a lack of enthusiasm in adoption and use.

How to address all this – admitting it is really very hard and there are no easy answers?

My approach would have (at least) the following elements:

1. Move the Health IT initiative out of the Health Department into a Central Agency Sponsored Entity that is properly resourced (i.e. don’t skimp) and led, and make it that the Health Agencies and Department have strong incentives to implement based on the compelling business case. This can increase the chance of strategic stability and ensure procurement is conducted properly and appropriately. Steady coherent progress is to be much preferred to spectacular disasters!

2. Ensure there is a coherent roadmap of the overall way forward for both organisations and the State as a whole rather that a restrictive command driven approach to making progress.

3. Provide incentives for implementation at the smallest local level possible and ensure there is a reasonable choice of systems for individual facilities to choose from. No ‘one size fits all’ approach – we know that doesn’t work!

4. Make sure benefits obtained can be retained locally and re-invested in further improvement where appropriate.

5. Have a major communication and education program to ensure all within the Hospital system understand the purpose of the Health IT investment is primarily to save patient’s lives and improve the quality and safety of care.

6. Carefully consider approaches that share risks and rewards with system providers for successful implementations.

7. Only have grand strategies and constraints on local flexibility where such things are needed to ensure the target health system can operate coherently. The use of relevant Standards can help here. Getting this central / local balance seems to me to be critical.

I am keen to have feedback on all this – as somehow we need to evolve a viable and workable new way!

David.

Health IT in NSW – Can it Go Much More Slowly?

Health IT in NSW has a long a proud tradition of glacial progress that extends all the way back to the 1980’s. Rather than run through all that history – which will be grist for another article in the future maybe – we should just consider the last few years.

Ministerial press releases make a fun retrospective! The circularity and repetition (a colleague would call it “Brownian Motion”) is just hilarious.

Let’s start in 2001. (My comments in italics)

http://www.health.nsw.gov.au/news/2001/February/02-02-01.html

Electronic health records - better care, your choice

“A SYSTEM of linked electronic health records (EHRs) will significantly improve patient care in NSW hospital patients within two years, the Minister for Health, Craig Knowles, said today.

The Minister today released a report into the privacy implications of the proposed system - Panacea or Placebo? Linked Electronic Health Records and Improvements in Health Outcomes - from the NSW Ministerial Advisory Committee on Privacy and Health Information, chaired by NSW Privacy Commissioner Chris Puplick.

The report explores the scope of electronic health records and how they can be implemented with an assurance of security and confidentiality. Following its release the public is being asked to comment on the recommendations.

NSW is leading the nation in its development of the electronic health record system.
Only patients who actively agree will have an electronic health record.

Mr Knowles said there were many advantages for patients who wanted this service.

"If you need to have multiple admissions to hospital it will be much easier for the treating doctors to have access to your records. This will greatly reduce the burden of repeating information many times and the risk of mistakes about, for example, which drugs a patient is taking, allergies or pre-existing medical conditions which could affect current illness or treatment," Mr Knowles said.

"Health record privacy is our top priority. A unique identifier system will help ensure access is strictly limited to authorised medical staff only.

""Of course, patients will have ultimate control. They can ask for the service, they can stop the service. To ensure the integrity of the system, patients will be able to get information about who has accessed their health records and when," Mr Knowles said.

The first stage of the electronic health record system is expected to start later this year.”

This was the first manifestation of Healthelink. Now six years later it is still in trial in two small areas and all the work done to decide the approach to privacy was overturned in 2005 as I recall. This was announced by the (Health Minister -4) (i.e. the fourth most recent Health Minister).

In late 2001 we had the release of the point-of-care clinical system (PoCCS) which was planned to support the clinical care process by enabling the doctor, nurse or allied health professional to:

· Record care where and when it is delivered

· Review progress and order treatment or tests from any workstation

· Continually review results and outcomes and alter care as required

· Be prompted with alerts and allergies at time of ordering

· Generate a clinical pathway or care plan to prescribe care for the patient's length of stay in hospital

· Monitor progress on the clinical pathway and record variances to analyse outcomes

· Utilise decision support at the time of ordering and on review of clinical outcomes

· Measure patient acuity to determine the intensity and complexity of care required and given

· Generate discharge referrals with automatic population of data from relevant systems e.g. radiology, pathology

The tender closed in February 2002 and after evaluation (which took a while) a selection was made (Cerner) and some implementations were begun in 2003 I understand.

Flashing forward to late 2002 it was all obviously getting too hard – so the retreat was made to paper.

Health Information - For The Record

Wednesday December 4, 2002

Health Minister Craig Knowles today launched the 'My Health Record' scheme, an initiative encouraging people to condense their medical information in one location to avoid confusion, time and expense when seeking medical treatment, and to increase the chances of a faster recovery.

An Australian first, the comprehensive 'My Health Record' booklet is being made available to more than 20,000 people in New South Wales who suffer chronic illnesses such as heart disease, respiratory disease and cancer.

Over the next 12 months, copies will be widely available to all people who frequently receive medical attention.

A centrepiece of the governments $45 million dollar Chronic Illness program, 'My Health Record' is available from local Doctors, hospitals and health centres for free. It includes pages and plastic sleeves where patients can voluntarily record dates and times of GP and hospital visits, diagnostic test results, procedures, medications taken, allergies and emergency contact numbers.

"For the first time we have a far-reaching scheme encouraging people to track their medical history and have the information at hands reach," Mr Knowles said.

"This is invaluable for better health outcomes, especially for people who seek treatment from multiple providers including doctors, hospitals and pharmacists on an ad hoc basis."

Chair of the NSW Chronic Illness Program, Professor Ron Penny, said the scheme was designed to ensure patients receive the most appropriate management of their condition at all times.

"It's about 'getting it right' early and ensuring patients are provided with continuity of care," Prof Penny said.

"It's an example of how we can reduce pressures on the health system by ensuring patients avoid unnecessary admissions and benefit from coordinated health care.

"Importantly, patients will no longer need to repeat their medical history over and over."

Mr. Knowles said almost one in five people admitted to NSW public hospitals (in 1999/2000) suffered chronic conditions including cancer, heart disease, asthma, arthritis, stroke and diabetes.

The admissions equate to 36% of total public hospital bed days, and cost $1.1 billion.

"'My Health Record' is a simple, cost effective program focussing on managing illness before it develops into a crisis," Mr Knowles said.

Obviously handling the information electronically was just too hard so this seemed like the next best option. Time moves on and suddenly we see Healthelink re-launched! (3 years later)

Minister launches Healthelink to put health records online

16 May 2004

NSW patients and parents of children in medical care will soon be able to log on to the internet and view their comprehensive medical histories following the signing of a contract to establish two pilots for an electronic health record system for NSW.

Minister for Health Morris Iemma, today announced the commencement of the groundbreaking $19.4 million program to put patients' medical records online.

The Health e-link will for the first time in NSW give GP's, specialists, emergency department clinicians and allied health workers online access to their patients' detailed medical histories and to the most up to date information on their treatment and medication.

"The Health e-link system will make our health system safer and more efficient, by making sure that clinicians all have access to the same information about their patients' medical histories," Mr Iemma said.

"Tests won't have to be repeated unless absolutely needed, nor will patients and carers have to recall from memory all aspects of care they received in the past.

"This new system means that whenever a patient visits the local doctor, the emergency department or a specialist all members of the health care team will have access to the same records.

"Illegible and incomplete hand written medical records can lead to mistakes being made and these are removed in Health e-link," Mr Iemma said.

The Minister said the system, which will be piloted at the Children's Hospital at Westmead and at Maitland and Raymond Terrace in the Hunter, will also provide patients with unprecedented access to their own medical records.

The electronic health record will include information on:

• Family history
• Allergies and alerts
• Medical and surgical history
• Procedures performed (pathology and radiology)
• Diagnostic results
• Multidisciplinary care plans

"In our health system, care is often not delivered by a single clinician," Mr Iemma said.

"Currently medical records are mainly stored physically in separate systems across hospitals, emergency departments, GP clinics, community health and outpatient clinics, diagnostic units and specialists' rooms," Mr Iemma said.

"So a clinician only has access to medical records that are physically stored in their own rooms and access for patients is extremely limited.

"The Health e-link system will allow clinicians and patients to log on and see all of their medical records, ranging from GP visits, prescriptions issued, blood test results, x-rays and hospital discharge notes," Mr Iemma said.

The Health e-link will likely result in:

• Greatly enhanced co-ordination and timeliness of care
• Less likelihood of adverse drug reactions due to unknown allergies
• Fewer diagnostic tests being unnecessarily repeated

Mr Iemma said that a consortium led by LogicaCMG, and including Orion International and Healthlink, had been selected to work with NSW Health to commence the pilot with a view to deliver a state-wide electronic health record system.

The first groups to participate in the pilot are

• Children aged 0 -15 accessing the public health system in the South Western Sydney, Wentworth and Western Sydney Area Health Services
• Chronic disease patients in Maitland and Raymond Terrace

Mr Iemma stressed that Health e-link has in-built security systems to ensure patient privacy and confidentiality.

Information will be password protected and each patient will have a unique patient number, individuals would only be able to access their own personal information.

Participation in the pilot will be voluntary.

The NSW Health e-link project is also a trial site for the national electronic health record system, HealthConnect, along with Tasmania, Queensland, South Australia and the Northern Territory.

Mr Iemma called on the Federal Government to make a genuine commitment to funding this program in NSW, citing the fact that Tasmania and South Australia have received generous grants as a result of Medicare Plus negotiations in the Senate, but not NSW or other states.”

Of course, as is well known, somehow the consent rules changed and rather than opt-in an opt-out approach was adopted. Of course, after another two years and now up to Health Minister – 2 the trial gets announced again – now five years after the initial launch!

Trial of Electronic Health Records

23 March 2006

Healthelink, the first NSW pilot of a revolutionary electronic health records system to improve patient care and speed up treatment, begins in the Hunter today.

NSW Minister for Health, John Hatzistergos, said the project will involve the secure collection and storage of eligible patients’ health information from Maitland Hospital, John Hunter Hospital, East Maitland and Raymond Terrace community health centres.

"Electronic health record systems will provide health care professionals with the medical patient information they need, when they need it,” Mr Hatzistergos said.

“This will make a big difference for patients and health-care staff - providing instant access to a patient’s records without having to contact their GP or wait for paper records to be retrieved.

“The Electronic Health Record has exciting potential: to unclog delays in the system and improve safety for patients.

“The information will be displayed in an electronic health record accessible by the patient and participating healthcare providers.

“That means, for example, that an emergency department specialist could quickly access a patient’s care details from other public hospitals or community health centres – giving them more information to provide better care.

“It also means that when the patient later visits their GP, the doctor can access vital information from the hospital about their treatment and condition. Hospital discharge summaries and patient test results will also be accessible through the system,” Mr Hatzistergos said.

“This is the first stage of the trial, in the next stage GPs will also be able to enter patient information into the system as well as being able to view records from hospitals.

Healthelink will initially be available for people aged 65 years and over living in the Maitland and Raymond Terrace areas – postcodes 2320 to 2324.

"Privacy and security have been a key focus during the development of the system and will continue to be our highest priority in the trial.

“All patient information will be held in a secure password-protected environment and in accordance with health privacy laws.

“This Healthelink pilot is completely voluntary, anybody who does not wish to take part will be able to opt out easily.

"The revolutionary pilot will test how well the Electronic Health Record will assist doctors and nurses in real-life healthcare situations, and we hope to learn from its use here in the Hunter,” Mr Hatzistergos said.

For a range of health information, go online to www.health.nsw.gov.au

Well that is a far as the Healthelink saga goes so far – the trial has been underway for 15 months and tenders have been called to evaluate what we got for the $19.5 million. (This is to be completed by the end of 2007) Of course in the mean time HealthConnect has largely vanished and broad implementation of Shared Electronic Health Records – under NEHTA’s guidance – is not seemingly proceeding apace with a business case not due until 2008 or 2009.

Moving back in time just 10 months we note that despite the 2002 PoCCS tender there have been some delays and problems. To fix this a new tender was released. The background is as follows

“In February 2002, the Department issued a Request for Tender (RFT) for a Point-of-Care Clinical System (RFT IT-135). As a result of this tender, Cerner Corporation’s Millennium software was made available to Area Health Services (Area(s)) via a period purchasing deed of agreement. A number of Areas are currently implementing the Cerner Millennium product.

The purpose of this tender process (RFT IT-190) is to evaluate current market offerings with a view to selecting a second EMR solution in order to provide remaining Areas with an alternative EMR product thereby providing a competitive environment.

The Department is conducting this tender process (RFT IT-190) to evaluate Tenderers capable of supplying the required EMR, that are willing to enter into a period contract with the NSW Department of Health for the implementation of an EMR in a number of the NSW Area Health Services in line with the requirements of this RFT.

Potentially four Areas could be seeking EMR implementations through the period contract arrangements resulting from this RFT. These are South Eastern Sydney Illawarra, Hunter New England, Greater Southern and Justice Health” (Quoted from 2005 Tender).

Here is the press release

Patients to benefit from online access to medical records

30 May 2005

Public hospital patients across NSW will have access to state of the art Electronic Medical Record (EMR) technology after the NSW Government today announced a call for tenders to expand the roll out of the EMR system, Health Minister Morris Iemma said today.

"The Electronic Medical Record is a foundation stone of our vision for how we will harness technology to improve patient care," Mr Iemma said.

"The Electronic Medical Record system will give clinicians online access to diagnostic tests for their patient carried out in hospital, regardless of whether as inpatient, outpatient or in emergency.

"From this base we aim to build a network that will ultimately allow consolidated test results to be accessed online from any authorised PC location across the state.

"So if a patient is admitted to Prince of Wales Hospital Emergency Department, their clinician will be able to access diagnostic test results done previously at Nepean Hospital or even Wagga Base Hospital.

"Improved access to clinical information can help reduce delays and give medical professionals the information they need to deliver the best possible care to patients," Mr Iemma said.

"This will be a significant boost for frontline health services delivering better access to a patient's clinical information wherever they are in the health system," Mr Iemma said.

"The system will also allow electronic charting making it easier for treating clinicians to detect trends in diagnostic results."

"NSW Health is looking to secure state-wide EMR coverage, and to do this it is seeking a second provider for point-of-care clinical system to those Areas that currently have not had a provider appointed," Mr Iemma said.

Mr Iemma said that online results reporting is already being used by Sydney West, Sydney South West, the Children's Hospital at Westmead and Central Coast and would be extended to Northern Sydney and Greater Western Area Health Services by early 2006.

This second call for tenders will see this technology rolled out to the remaining Area Health Services.

The Minister said that privacy and security will be assured as each clinician is given a unique identification and password to access the system.

Preserving system integrity and patient privacy are critically important aspects of the project and NSW Health will take all necessary steps to ensure patient confidentiality is maintained.

Roll out of the software will be managed through HealthTechnology, the new shared IT services agency established as part of the restructure of the state health information management and technology function.

As we now know the second tender got nowhere!

Electronic Medical Record Tender Closes with no vendor meeting all requirements

09 February 2006

NSW Health today announced that it would review its options for its second Electronic Medical Record (EMR) solution after concluding that no single product presented in the tender could meet the defined requirements to a satisfactory level.

NSW Health's Chief Information Officer, Michael Rillstone, said that while he was sympathetic to vendors, who had put in a significant effort, it was important that NSW Health move forward with its EMR program with confidence that the needs of Area Health Services would be met with minimal disruption to front line health services.

"A number of the clinical information systems presented were currently under development and while these may yet meet NSW Health's requirements in the future, at present they represented too high a risk on a number of fronts.

"We only have one chance to get this right. Health is a complex environment, and that does not mix well with high-risk software implementations, as we have seen in the past.

"Nine responses were received. A comprehensive evaluation found that no single product could meet to tender requirements to a satisfactory level," said Mr Rillstone.

The EMR is aimed at providing an information system that will enhance the health care of people attending NSW public hospitals. It will allow statewide coverage of clinical information systems with the goal of making comprehensive information available to treating clinicians, no matter where a patient enters our health system.

Mr Rillstone said that key modules of the EMR strategy have already been rolled out over the past three years into two Area Health Services and the Children's Hospital at Westmead.

The selection of a second vendor was preferred because it provided a more competitive environment with alternate product options. However, this approach represents no advantage if it comes with significantly higher implementation risks.

"Sound health care and clinical decision-making is enhanced by timely access to quality information.

"For example, having the test results of a patient in hospital quickly integrated into their treatment notes so that treating clinicians can consider the results in the context of the patient's overall condition and current therapies to make timely decisions," Mr Rillstone said.

The Chief Information Officer said it was important to understand that NSW Health remained committed to delivering an EMR and that improving the quality and timeliness of patient care and providing support to busy clinicians as they care for their patients was a priority.

While the current second EMR tender outcome is a setback, work has begun immediately on reviewing the options for moving forward aimed at minimising any delay.

And to come full circle we now have an article in the Financial Review telling us the following – and revealing just how long it has taken to work out what to do after the failed tender:

http://www.misaustralia.com/viewer.aspx?EDP://20070720000019155824&magsection=news-headlines&portal=_mis&title=NSW+e-health+system+to+log+on+in+2008

NSW e-health system to log on in 2008

Renai LeMay

The Australian Financial Review | 20 Jul 2007 | Information

The NSW government's $40 million computer project to eliminate paper patient records in public hospitals is gathering speed.

NSW Health's area divisions are currently ramping up preparations for the project, with implementation of US health giant Cerner's technology scheduled to take place from early next year.

The project, in the works since 2002, will give NSW's 84,000 medical staff electronic access to millions of patient clinical records and test results across more than 180 public hospitals.

It is one component of the $300 million that NSW has allocated to public e-health until 2009.

The South-Eastern Sydney & Illawarra Area Health Service (SESIHS) will be one of the first divisions within NSW Health to try the technology. The division's chief information officer, Jean Evans, told The Australian Financial Review that St George Hospital in the Sydney suburb of Kogarah would be the first to receive the new systems in March next year.

Sutherland Hospital will follow soon after, with the division to implement the new computer systems within all of its 19 hospitals by the end of 2008.

"We're not the only area, but we're the first one to go with the full functionality," Ms Evans said. The entire state-wide system is due to be completed in 2009.

….. (see the full article at URL above)

I think it is fair to say that the progress in all this can only be characterised as glacial and essentially incompetent. It simply should not take this long to get reasonable Health IT Support into our major hospitals.

I really wonder how all these slow-coaches sleep at night considering the number of preventable clinical errors and deaths they are failing to prevent by moving at their present snail’s pace!

David.