Australia’s Peak Professional Health IT Organisation Speaks on the NEHTA Review.

While contributing to the recently released Health Information Society of Australia (HISA) Submission to the NEHTA Review, the Australian College of Health Informatics (ACHI) has also developed its own submission.

The submission can be found here.

In addressing the question of whether NEHTA is meeting is objectives the submission points out:

“When we consider each of the objectives in S3.2 of the NEHTA constitution, the report card is not very impressive. Some progress is seen in the work on clinical data standards and terminologies. However, it is the continuation of work already started on SNOMED CT, which only became official in May 2007. The implementation program is neither explicit nor transparent, which precludes any informed comment on actual progress on the ground.”

The report then goes on to say there is uncertainty as to where other major initiatives are presently situated saying “However, lack of information sharing (by NEHTA to the e-Health Community) prevents informed comment as to whether the R&D is sound and consistent with parallel developments in national and international standards programs.”

When asked to address the question of whether NEHTA was given the appropriate objective the ACHI report remarks:

“When a NEHTA was recommended following the BCG report in 2004, our expectations was that all the R&D done to date by a range of agencies would be harnessed into a national implementation strategy and plan, along with a compelling business case. A role of a NEHTA would be to coordinate the development of this plan as a matter of urgency and get down to the business of implementing and monitoring the success of the implementation plan.”

As is now well known, of course, this plan never happened, or if it did it was never made available to the e-Health Community.

ACHI is also moved to point out that:

“It would be fair to say that there has been little substantial progress during NEHTA’s tenure as a player in this standards and infrastructure domain. NEHTA has delivered a number of summary documents of existing work and re-badged plans for the future. These are general and basic documents not just to the Health Informatician but also to computer science students who have been asked to examine them for academic purposes. “

ACHI also notes that while there has been progress with SNOMED CT and some apparent work in the area of e-Health Benefits Realisation the actual cumulative progress is very hard to estimate.

Among other key points ACHI notes the lack of consultation or inclusiveness with the ACHI membership despite a number of offers and meetings.

I will quote the final Summary in full:

Summary

“ACHI believes that NEHTA has not achieved what it was tasked to do and is unlikely to do so if it continues as is. The reasons include the vagueness of what was prescribed in the constitution of NEHTA in the first place, the lack of a clinical or health focus, a poor communication and engagement strategy, a governance structure which emphasised the jurisdictions and hospital-based systems, a lack of emphasis on capacity building, a lack of quality monitoring and evaluation, and a lack of clear deliverables and key performance indicators (KPIs). The key factor is a lack of national direction, leading to a lack of a national vision for the EHR system, and therefore a lack of a national implementation plan, budget and support.

We believe that what NEHTA is supposed to be doing is very important but that NEHTA is not doing it well. Along with the HISA survey, we believe that this is a widespread and consistent view from informed stakeholders, whose support is essential to achieve the objectives tasked to NEHTA.

There needs to be a concerted shift to a program of systematic implementation and management of the change to the health system as the implementation gets underway. Capacity building and a safety and quality improvement culture is essential, with built-in data collection and monitoring processes and systems to provide the evidence of improvement to cost-efficiencies and health outcomes.

ACHI stands ready to contribute to the development, implementation and monitoring of this nationally agreed implementation plan for a national EHR system and e-Health program”

Where does all this leave us?

I would suggest that, with both the earlier HISA and ACHI submission virtually totally aligned on all the key points under review, fundamental change in the way NEHTA operates and the objectives it pursues needs to be very fully re-assessed.

It seems clear to me it is the clear expectation of the e-Health Community that fundamental and deep change is both underway and required.

For the NEHTA Board to continue in its mode of denial and obfuscation is becoming increasingly un-tenable. Definitive action to access the broad range of e-Health skills available outside NEHTA is vital and is required and sooner rather than later! Facilitated by the BCG, the Board should engage in an inclusive Strategic Planning Process to minimise any further waste of NEHTA work and get the overall direction of e-Health back on a track that has the vast majority of stakeholder support. Without such a process no one can know what can best be done with what we now have in NEHTA and how it can best be shaped to serve the National E-Health Agenda in the future.

David.

Useful and Interesting Health IT Links from the Last Week – 12/08/2007

Again, in the last week, I have come across a few reports and news items which are worth passing on.

These include first:

http://www.theaustralian.news.com.au/story/0,25197,22225026-23289,00.html

Girls seek thinspiration on web

Helen Nugent, London | August 11, 2007

CHARITIES involved with eating disorders have called for tighter controls on the internet after it emerged that sites such as MySpace and YouTube were being used to promote anorexia.

Pro-anorexia websites, on which girls exchange extreme dieting tips and view "thinspiration" videos featuring alarmingly thin women, had always been difficult to find and the people posting on them had remained anonymous.

But pictures and footage of underweight teenagers are appearing on more mainstream sites, reaching a potential audience of tens of millions.

On Facebook, some groups extol the virtues of anorexia as a lifestyle choice.

Thousands of people have viewed film clips of emaciated teens and 20-something women on YouTube which, along with the other networking sites, has rules against posting harmful content. The two-minute to 10-minute videos often feature the more slender celebrities such as Victoria Beckham and Kate Moss, and show images of underweight women in their underwear.

Eating disorder charities have called on social websites to look closely at their online material.

Susan Ringwood, chief executive of the charity Beat, said: "Pro-anorexic sites weren't easy to find and most responsible internet providers would cut them out. But on the networking sites, there isn't the same control over them.

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

This is a worrying article on a trend where really stupid people try to exploit you insecure teenagers on the web – oh and buy the way we will make money out of their distress. Pretty sad.

Second we have:

http://www.computerworlduk.com/management/it-business/services-sourcing/news/index.cfm?newsid=4422

iSoft will deliver NHS system to CSC 'in new year'

Troubled software supplier confirms Lorenzo handover timetable

By Tash Shifrin

Troubled NHS software supplier iSoft will deliver its Lorenzo care records system to CSC by early 2008, it has said. This will leave the way clear for CSC to start rolling it out to the NHS National Programme for IT from mid-2008 onwards.

It set out the timetable in posting a 13% drop in revenues to £175.2m and a 50% fall in “normalised operating profits” as it limps towards its acquisition by German firm CompuGroup.

The software supplier is contracted to provide the Lorenzo care records system as the core part of the NHS’s £12.4bn National Programme for IT (NPfIT) in three out of five regions where CSC is the lead contractor.

But the turmoil surrounding the company has increased concern about the delivery of Lorenzo, which is already running more than two years late.

Last month, iSoft announced its shock sale to CompuGroup, abandoning previous moves to sell to Australian firm IBA.

The full-year figures for iSoft figures a pre-tax loss of £22m, mainly as a result of restructuring efforts, but this is down from the dramatic £343.8m loss posted by iSoft last year.

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

It seems the outcome with iSoft is pretty much settled and it now seems at least hopeful that the regions who were to get iSoft software will now get a working product. We can only hope so. For IBA the time has now come to work out what is best done with the additional capital they now have for the benefit of their shareholders (of which I am one).

Further information is found here:

http://www.whatpc.co.uk/computing/analysis/2196243/lorenzo-software-vital-isoft

Lorenzo software vital to iSoft's future

Healthcare supplier relies on NHS developments for future revenue growth, reports Dave Friedlos

Dave Friedlos, Computing 09 Aug 2007

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

Third we have:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070808/FREE/308080001/1029/FREE

Six EMRs have CCHIT seal of approval so far

By: Andis Robeznieks / HITS staff writer

Story posted: August 8, 2007 - 5:59 am EDT

So far, six ambulatory electronic medical-record products have passed muster with the Certification Commission for Healthcare Information Technology's 2007 criteria for functionality, interoperability and security.

Those products are:

• Auburn, N.Y.-based Community Computer Service's Medent 17.
• Austin, Texas-based e-MDs' Solution Series 6.1.2.
• Carrollton, Ga.-based Greenway Medical Technologies' PrimeSuite 2007 R2.
• Alpharetta, Ga.-based McKesson Provider Technologies' Practice Partner 9.2.1.
• Horsham, Pa.-based NextGen Healthcare Information Systems' EMR 5.4.29.
• St. Louis-based Purkinje's CareSeries EHR 2.0.
• 
  

Some 89 ambulatory EHR products were certified under the 2006 criteria. If vendors want to continue marketing those EHRs with the 2006 CCHIT seal of approval beyond a 12-month period, commission spokeswoman Sue Reber said they will need to pay a $4,000 "maintenance" fee. Vendors seeking to keep old products certified and eligible for the 2006 seal while submitting new versions of the product for testing under the new criteria will need to pay a $4,000 maintenance fee plus the $28,000 fee for the certification test.

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

Just a reminder that the Certification Commission for Healthcare Information Technology in the US is steaming on progressively improving the quality and usability of ambulatory systems available to US clinicians. Good if was saw such a rational process set up on OZ!

Fourth we have:

http://today.reuters.com/news/articlenews.aspx?type=healthNews&storyid=2007-08-07T192933Z_01_N07236643_RTRUKOC_0_US-DISEASE-PREVENTION.xml&src=nl_ushealth1100

Preventive steps could save 100,000 U.S. lives: study

Tue Aug 7, 2007 3:29 PM ET

By Julie Steenhuysen

CHICAGO (Reuters) - Increased use of just five preventive services would save more than 100,000 lives every year in the United States, health experts said in a report released on Tuesday.

Of the five prevention tips, the biggest impact would come if adults took a low dose of aspirin every day to prevent heart disease, a step that could save 45,000 lives a year.

The report by the Partnership for Prevention, a nonprofit health policy group, also calls for renewed efforts to help smokers quit, more colorectal cancer and breast cancer screening and annual flu shots for people over 50.

"This shows so dramatically the potential impact of prevention," said Dr. Kathleen Toomey of the federal Centers for Disease Control and Prevention, which helped fund the study along with the Robert Wood Johnson Foundation and the WellPoint Foundation.

"These are really very modest, low-cost interventions that have such potentially dramatic impact on improving the health of the public," Toomey said in a telephone interview.

The study underscores the tendency in the United States to treat disease, rather than prevent it.

"Our nation has never truly invested in prevention," Toomey said.

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

A useful reminder of the importance of preventative health care – which, of course – is an area where e-health applications can make a major difference.

Fifth we have:

http://www.ehealtheurope.net/news/2935/ireland_to_invest_euros_500m_in_e-health

Ireland to invest Euros 500m in e-health

08 Aug 2007

The Irish Government will commit almost half a billion Euros of investment to e-health when it publishes its National Development Plan for health.

Investment will be focused on systems that improve patient care in hospital or community settings, with a particular focus on supporting community-based health professionals.

As part of the National Development Plan (NDP) the Irish Government plans to invest Euros 490m in e-health over the next seven years, at a level of Euros 70m a year.

After a lengthy planning and tendering process, the new investment programme will be formally announced when Ireland unveils its Health Information and Communication Technology sub-programme in the NDP for 2007-2013.

The six-year investment plan is intended to provide the funding to deliver Ireland's National Health Information Strategy, first published in 2004. The document is expected to lay out detailed updated plans for implementing the 2004 e-health strategy.

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

An now we have countries with only 4.1 million people planning to actually get moving in e-health. If scaled to the size of the Australian Population this amounts to $2.5 Billion Euro (i.e. $A 4.0 Billion). Nice it we had a national government with similar vision.

Lastly we have:

http://www.govhealthit.com/article103468-08-10-07-Web

Report: EMRs should have anti-fraud features

BY Nancy Ferris

Published on Aug. 10, 2007 A contractor is recommending that the Health and Human Services Department beef up its anti-fraud efforts with respect to health information technology and medical billing.

The contractor, RTI International, delivered to HHS’ Office of the National Coordinator for Health IT a report listing 14 kinds of features that should be built into electronic medical records to prevent fraudulent billing and help spot fraud once bills have been transmitted for payment.

Of the 14 recommended features, nearly one-quarter already are being required for certification by the Certification Commission for Health IT, an HHS-sponsored organization that reviews EMR products to determine whether their functionality, interoperability and security meet certain standards.

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

The report – which is available at www.dhhs.gov/healthit - is well worth a review. It shows how ONCHIT, CCHIT and commerce are working together to get incremental improvement in the systems used by American Clinicians – again a useful idea for OZ!

Special tip for the week. Those with an interest in Health Policy should subscribe to the weekly e-mail provided. The Australian Policy Online Website can be found at:

http://www.apo.org.au/index.shtml

The APO Weekly Briefing may also be viewed online at http://www.apo.org.au/infocast/ or email admin@apo.org.au for a plain text version.

This group is based at Swinburn. The site self describes what they do:

With nearly 120 member centres and institutes, Australian Policy Online offers easy access to much of the best Australian social, economic, cultural and political research available online. APO is maintained by the Institute for Social Research at Swinburne University of Technology, with support from the Centre for Cultural Research at the University of Western Sydney, the Gilbert + Tobin Centre of Public Law at the University of New South Wales, the Discipline of Government and International Relations at the University of Sydney, the School of Political and Social Inquiry at Monash University and the National Library of Australia, together with over 160 centres and institutes around Australia. To learn more about our member organisations, visit our Members page.

APO is grateful for funding from the Australian Research Council, which assisted the development of the site during 2004–06. Funding for Asia–Pacific material on the site is provided by the David C. Lam Institute for East-West Studies.

Reports and other new material from our members are archived within our Topics pages, which are arranged according to broad subject areas. Our team of guest writers and columnists weigh in on issues of the day within the pages of Comment and Analysis.

To receive notice of new material at APO, as well as job openings, events, and other notices from Australia’s public policy research community, join over 4600 people in subscribing to Weekly Briefing, our free weekly email newsletter. Simply enter your email address in the box on the left of your screen.

Highly Recommended.

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

More next week.

David.

When Are We to Hear From AHIC Again? It Had Better be Very Soon!

Well over two months ago we learned that the Australian Health Information Council (AHIC) will be holding a summit on June 18 (evening) and 19, involving AHIC and the National Health Information Management Principle Committee (NHIMPC).

We also learned that in AHIC’s role of providing advice to inform national policy direction for health information to the Australian Health Minister’s Advisory Committee (AHMAC), AHIC wished to look strategically at the development of the national health information program out to 2013.

To ensure wide coverage by the summit, the consultants that were engaged to conduct a survey, were asked to develop a systematic analysis of:

• what’s worked and what hasn’t up until now
• where Summit participants and your constituencies (if relevant) stand on the health policy imperatives moving forward
• what should be in place by 2013 (or before) in terms of e-Health infrastructure and specific IT and communications tools to serve those health policy goals, and
• what might be the right model(s) moving forward.

We were also told the survey would be collated and presented in advance of the summit.

Well the survey was conducted and there were a range of thoughtful submissions – including a very thorough one from the Health Informatics Society of Australia. This can be downloaded here.

The Summit has also occurred I am told.. and all went very well I am also assured.

BUT – essentially two months later, who other than the members know what went on, what was decided and so on.

Since suddenly being resurrected (in very early 2007) AHIC has now had at least three meetings and conducted a Summit. All the taxpayer has seen is consulting bills and a one page say nothing communiqué (released in April 2007).

I am sorry but it just defies belief that release of at least some background information on the directions work is pursing and what are the expected outcome(s) has not happened by now. This committee makes the National Security Committee of Cabinet seem transparent by comparison!

As noted in the spin laden release from NEHTA Chair “There is widespread agreement across the health sector that the pursuit of e-health in a nationally coordinated strategy is crucial for Australia. Agreement about the importance of this national agenda is shared even by those individuals and organisations that may from time to time critique NEHTA’s work.”

It seems to me that, in part at least, this is a central part of what AHIC is meant to be doing.

AHIC has a responsibility not to repeat the mistakes that have been made by NEHTA and which have successfully alienated virtually all worthwhile contributors to e-Health in Australia. It must be open, communicating and transparent in all its processes and lead in a way that makes the Health Sector feel it is understood! It must also communicate promptly, not months after the event.

Wake up AHIC team (and Chair, Professor Prof James Angus, Dean of the Faculty of Medicine, Melbourne University in particular) before you find you achieve levels of irrelevance you can only dream of, and are swept away in the tsunami of a change of Government never to be heard from again!

David.

Medinfo 2007 – A Real Australian First!

Time is getting very short to be a lucky attendee at Brisbane’s Medinfo 2007.

Medinfo 2007 will be held from August 20 - 24, 2007 at the Brisbane Convention Centre, Southbank Brisbane. Workshops and tutorials will be held on August 19 & 20 at the venue.

Medinfo has brought together experts who are leaders in the design, implementation and theory of eHealth, practitioners who can speak with the authority of experience. Importantly, by bringing these experts together in the one congress, we create the opportunity for that unique symbiosis of talent that leads to stimulation of new inspirational concepts and directions.

We have put together a full list of keynote speakers below

• Maxwell R. Bennett AO, Professor of Neuroscience University Chair and Scientific Director Brain and Mind Research Institute University of Sydney, Australia

• Paul Gilding, Ecos Corporation, Australia

• Sir Muir Gray, Director of Clinical Knowledge, Process and Safety, NHS Connecting for Health England

• Brendan Kelly, Chief Advisor, Health Information Strategy and Policy New Zealand Health Information Service Ministry of Health

• Robert Kolodner MD, National Health Information Technology Coordinator (ONC), United States of America

• Sarah Kramer, Vice President and CIO at Cancer Care Ontario, Canada

• Marc Probst, Vice President and CIO, Information Systems, Intermountain Healthcare, USA

• Dr Ian Reinecke, Chief Executive Officer, National eHealth Transition Authority, Australia

• Sol Trujillo, Chief Executive Officer Telstra Corporation Limited Australia

Not only is there the main conference – program available on the website at www.medinfo2007.org – there are also the other associated events.

First World Conference on Pathology Informatics (WCPI) Brisbane Convention Centre 16-17 August 2007; preconference workshop 15th August.

Third Information Technology in Health Care (ITHC) Socio-technical Approaches Sydney; 28 August workshop, registration and conference 28-30 August 2007

1st World Nursing Informatics Leadership Conference
To be held in conjunction with Medinfo 2007 August 2007, Australia Venue: Brisbane Convention Centre, River Room, Southbank Sunday 19 and Monday 20 August 2007

Medinfo 2007 is now so close we can taste it and there is not much time to get registered and make your plans to attend!

For Australians this is a virtually unique opportunity to access such a range of global expertise for such a small cost.

Remember this is a once in only every three year event – and this is the first time it has been held in the Southern Hemisphere!

To register, please go to

www.hisa.org.au

and register online or download a registration form and fax it to us. Alternatively you can email us at conference@hisa.org.au , or call us at +613-9388-0555.

As people always used to say to me in my youth – “be there, or be square!”

David.

WCPI 2007: The First World Congress on Pathology Informatics – A Unique Opportunity!

As a Health Informatics Community service I want to alert all readers to this first ever World Congress on Pathology Informatics!

A summary of the Congress’s contents is as follows:

“You are invited by The Health Informatics Society of Australia and the Association for Pathology Informatics to attend the first World Congress in Pathology Informatics to be held 16th-17th August 2007 immediately prior to Medinfo in Brisbane Australia.

The Congress addresses key pathology informatics issues from both a regional and technology perspective. The program is supported by a field of eminent invited speakers. On the first day practical examples of innovation across the globe by geographic region will be highlighted and on the second day there will be updates on eight of the most important themes in pathology informatics, namely:

• Automation - Leveraging pathologist's knowledge with workforce shortage; Probabilistic diagnosis; Machine learning; and Laboratory processes
• Digital Microscopy - Sharing; searching; and analysing pictures
• Omics – Will the laboratory of the future only need micro arrays, NMR spectroscopy and a Mass spectrometer; Bioinformatics in pathology
• Shared Care - Pathology's role in the shared EHR
• Disease Surveillance - Registries; Early warning systems; eNotification
• Standards Development - Messaging; Terminology; and Decision support
• Pathology Order Entry - Guideline representation; Decision support and Terminology
• Micro Electro-Mechanical Systems – Single chip analytical systems
• 
  

In addition to these invited reviews, there will be 16 twenty minute presentations of the best submitted work based on peer review.”

Invited Speakers Include:

• Prof Francis Bowling: Mater Childrens Hospital, Brisbane
• Prof Kojo Elenitoba-Johnson: University of Michigan
• Prof Sam Heard: Open EHR Foundation
• Prof Jonathan Kay: John Radcliffe Hospital, Oxford
• Prof Mark Routbort: MD Anderson Cancer Center, Houston
• Prof Ronald Tompkins: Harvard Medical School
• Prof Mehmet Toner: Harvard Medical School

Vastly more information can be found at the Congress Web Site including information on the preliminary one day introductory pathology informatics workshop on the 15^th of August, 2007.

You can register on-line from the URL above!

This will be a unique opportunity for Australians interested in the areas to rub shoulders with the best in the field.

Details of the program for the Introductory Workshop is available here:

The Main Program is available here:

Please consider if you can afford to miss this fantastic event! Missing this faculty and program may mean you never make a wonderfully interesting and profitable career change!

David.

The NEHTA Chair Completely Misses the Point!

Presumably in response to the release of the HISA Survey of NEHTA performance, earlier today, the Board Chair has released the following!

NEHTA welcomes debate on its role as peak e-health body - message from Uschi Schreiber, NEHTA Chair

7 August, 2007. The Board of the National E-Health Authority welcomes public debate about the important role NEHTA plays as the peak e-health body in Australia.

One of the objectives of the review of NEHTA commissioned by the Board and currently being conducted by Boston Consulting Group is to seek the widest possible input into determining the next steps for e-health in Australia.

The Board of NEHTA, composed of all the heads of health agencies in Australia, reaffirms the importance of NEHTA as a key driver of healthcare reform by accelerating the pace of the national e-health agenda.

There is widespread agreement across the health sector that the pursuit of e-health in a nationally coordinated strategy is crucial for Australia. Agreement about the importance of this national agenda is shared even by those individuals and organisations that may from time to time critique NEHTA’s work.

The current review of NEHTA was built into the organisation’s constitution when it was established two years ago and will assist the Board in framing the future evolution of e-health.

The outcome of the review being conducted by Boston Consulting Group will be an independent assessment of and status report on NEHTA’s progress to date. It will also make recommendations for the Board’s consideration of NEHTA’s future role and direction.

The Board of NEHTA welcomes the active engagement of interested parties during the course of the review and will take all views into account when Boston Consulting Group presents its recommendations in October.

Uschi Schreiber

Chair, NEHTA Board

In saying the BCG “seek the widest possible input into determining the next steps for e-health in Australia.” It is assumed some useful steps have been taken so far. The evidence would not really support that contention!

What this release shows is that the NEHTA Board is basically unable to appreciate how badly it has failed in serving the Australian e-Health Community in setting the directions and strategies to be followed by NEHTA. The e-Health community the Board is meant to be serving has labelled NEHTA a resounding failure but it keeps thinking that it is a good thing to “reaffirm the importance of NEHTA as a key driver of healthcare reform by accelerating the pace of the national e-health agenda.”

Then it goes on to say “There is widespread agreement across the health sector that the pursuit of e-health in a nationally coordinated strategy is crucial for Australia.” So why hasn’t NEHTA announced it is developing one? Could it be that NEHTA is not being led by its Board? I have been suggesting a plan is needed for the last 18 months and all I, and others, have got from NETHA is airy dismissals.

We also get "Agreement about the importance of this national agenda is shared even by those individuals and organisations that may from time to time critique NEHTA’s work." Sadly NEHTA Board has offered no national agenda anyone has been told about!

Last we get to the serious issue. The release says “The outcome of the review being conducted by Boston Consulting Group will be an independent assessment of and status report on NEHTA’s progress to date. It will also make recommendations for the Board’s consideration of NEHTA’s future role and direction”

Just why is the Board considering what should happen to it? It is fundamentally and existentially conflicted in doing that – and worse it doesn’t seem to get it!

NEHTA is a major problem, not a solution, and its Board is a very big part of that problem.

This release is a plea for the status quo when what is needed is root and branch change!

David.

Results of the HISA Survey of NEHTA’s Performance – The Beginning of the End for “Old NEHTA”

Today (Tuesday August 7, 2007)HISA is making public the results of its membership survey on NEHTA’s performance over the last (almost) three years since its initial instigation by the Australian Health Minister’s Council early in 2004.

The core finding from the survey (which attracted over 180 responses) is found in the conclusion. It reads as follows:

“That NEHTA's performance is not matching expectation is the major and consistent outcome of this comprehensive opinion survey evaluating the first two and half years of NEHTA's operation.

The survey is well-designed and broad-based with a good response rate and with significant effort provided by the respondents to consider and convey the issues and to provide suggestions for improvement. It cannot be easily dismissed as a factional view. This is a consistent view from informed stakeholders whose support will be required to achieve the high level objectives for health system change that were intended from NEHTA coming into existence.

Issues related to the level and manner of engagement with the health community and the style of operation and leadership were repeatedly identified. The difficult task that NEHTA has is to take the highly intelligent and independently minded members of the Australian healthcare system and get them to do something that will often mean more work, and deliver little value directly to them, at least in the short term. The hallmark of leadership in this type of environment is the ability to engage, listen and bind this diverse group together with a common purpose.

This is the critical task for NEHTA, the task at which, according to the feedback from this survey, it is not achieving. It is not really a question of technology, most of the critical technology problems have been solved to a large degree. It is an ability to engage the Australian healthcare community in an agreed plan and involve them in the standardisation process, ensuring they are the final owner and driver of the outcome.

Australia does not have the resources to engage in a UK, NHS style “top down” approach to delivering eHealth. Nor would it be the best use of those resources if we had them. We need to intelligently leverage the rich resources that we have, engage with vendors and clinical participants, decide what problems need to be addressed locally and what nationally, and most importantly bring the Australian eHealth community along on the journey.

There is no doubt that there are some talented and open people within NEHTA, but their contributions appear to be blunted by isolation from the broader Australian eHealth Community. The results of this survey are starkly clear, in spite of the talent within NEHTA, it is not performing to community and stakeholder expectations. It needs to better engage, listen, and leverage the broader talent pool in Australian eHealth. In doing this, it needs to be a participant and in some cases to lead in galvanizing both the eHealth and broader healthcare communities together in the common goal of delivering a safer and more efficient healthcare system for Australia through the application of eHealth systems and processes.

It would be better to resolve these important issues around engagement and style within the existing structures to avoid a repeat of the hiatus that occurred with the formation of NEHTA.

There is close co-operation between HISA and the Australian College of Health Informatics (ACHI) with all ACHI Fellows also members of HISA. There is a strong view from the membership of both organisations that Australia is not moving fast enough to improve health information systems and that Australia lacks an agreed and resourced plan to address this to realise the benefits that are now becoming well accepted internationally. HISA stands ready and able to contribute and support the development of this national plan.”

The full report can be found here.

What will be interesting from now is, with some really hard and credible data available as to NEHTA’s performance, is what will happen next.

On the basis that this is only one of five different submissions to the BCG review which have provided very adverse, and very similar, commentary that I am aware of, one can only hope that major change will eventuate.

The threads of:

1. Not loosing any momentum that is presently underway.

2. Developing a new plan defining who does what with whom and who is responsible for which outcomes.

3. The need for a radically different management style and approach for the current NEHTA.

Are vital. Are all present in all the submissions I have seen!

All these points, and much else, is crucial. Let us hope the outcome of the Boston Consulting Group’s NEHTA Review accurately reflects these messages.

The BCG needs to be very clear that NEHTA has spent / is planning to spend almost $200 Million by 2009 (The COAG funds $130M + operation expenses of approximately $15M + pa for four years). This is a very large sum of money and how it has been spent needs to be very carefully reviewed. (For example does NEHTA actually need a quite palatially fitted out suite on
Level 25, 56 Pitt Street, Sydney NSW 2000?) (Chatswood, Macquarie Park etc would have been as good)

Just look at how the Royal Exchange Building portrays itself!

“With frontage to three streets this prominent corner position enables the Royal Exchange Building to take advantage of excellent natural light and good harbour views to the north-east particularly from the upper levels. The high rise floors present magnificent northerly and easterly views including Circular Quay, the Opera House and the Botanic Gardens. To the west the aspect is no less spectacular enjoying expansive views of the City and beyond creating an evocative backdrop particularly at sunset.

The central CBD location is only a short distance from Wynyard Railway Station and the bus ferry and rail transport at Circular Quay. Equally close in all directions are some of Sydney's leading international five star hotels, and a wide selection of Sydney's finest shops restaurants and entertainment. “

Nice spot if you can afford it – for more amazing information on how money is being wasted go to:

http://ebuilding.com.au/56pittstreet,sydney/jadehttp.dll?EBDWebsite_002

Let us also hope DoHA recognises the appalling conflict the NEHTA Board finds itself in – being the recipient of a consultant report which is very likely to suggest their oversight of NEHTA has been highly unsuccessful – at best. They should take the management of this project back to the Department itself and so free the consultants to do their job fearlessly and honestly.

I must say the work presented here re-assures me I have not been wasting my time pushing for major change in NEHTA.

Wait now for the “Empire to Strike Back”. The attempts at spin, backdoor attacks on the credibility of all those involved, denial of the validity or the survey and claims of bias on the part of the authors will be fascinating to watch.

I suspect we will also hear claims – we are doing great, this all just takes time so give us more time (duration unspecified) and we can prove how wonderful we really are!

In order to counter all this one should ask the following question. Just how many commercial vendors have actually signed up to use the NEHTA’s patient and provider identity services and what will this service cost into the future when the initial funding is used up? I think the answer is none and no-one knows.

Another issue, now it is clear that major change at NEHTA is warranted is the status of all those staff hired on two and three year contracts. Some will surely be in areas now seen as not strategic or useful. Even if there are 20 of the 100 or so staff who have to be paid out (given $250,000 per person in total employment costs would be usual for a two year contract) that could be $5.0 million paid, after the event, on wasted staff.

Further, longer than six month, recruitment by NEHTA should obviously be deferred until clarity is available.

I commend the survey to you for a very close read – it is really good to see the truth out once in a while!

David.

Press Commentary is now available:

1. MIS Australia

2. Australian IT

D.

A Tiny Rumour from Crikey.Com.au. – For Your Reading Pleasure

“Victorian DHS Healthsmart over budget?

How do you keep a program running when it is over budget, has delivered little and hospitals don't have the money to use its systems? If you give the hospitals the money the cost will be allocated against the program. If you provide the systems the costs will be allocated against the program... but if you give the hospitals an interest free loan to pay for the systems that they are supposed to pay back in five years the costs can be hidden and who will be around then anyway?”

The answer to that question - as we see from yesterday's post is virtually nobody!

I wonder is it true?

Not often e-health gets a run in Crikey. Good on them and thanks for this tit-bit!

It almost sounds like another e-Health initiative I can think of. Stay tuned for huge breaking news in that domain tomorrow.

David.