Minister Roxon Really Wants To Share the Possible PCEHR Pain Around. Everyone Gets a Mention.

I wandered along to the Commonwealth Health Department Site earlier today and was greeted with a blizzard of press releases on the Wave 2 projects.

There is no doubt the Government is keen to play up just how wonderful they are for providing $55 Million for what are really glorified pilots and little else.

Here is the e-Health list:

29 March 2011

Brisbane leads the way as e-health super site

Brisbane will the lead the way as an Australian e-health ‘super site’ following new e-health projects announced as a part of national health reform.

29 March 2011

E-Health benefits spread as Canberra team chosen to lead roll-out

Aged and palliative care patients in the ACT will benefit from better integrated and safer care through e-health systems developed by a team from Canberra that has been chosen as one of nine new projects to lead the roll-out of e-health records.

29 March 2011

E-Health Benefits Spread as Nine New Sites Start Work

Mothers and new born babies, Australians suffering from chronic disease and patients in aged and palliative care are some of the first groups set to benefit from national health reform as nine new locations have been selected to lead the roll-out of e-health records.

29 March 2011

E-Health benefits spread as Sydney team chosen to lead roll-out

Patients are set to benefit from a better, safer and more integrated medical records system to be developed by a consortium of Sydney health providers that have been chosen as one of nine new projects to lead the roll-out of e-health records.

29 March 2011

E-Health benefits spread into Western Sydney

Mums and bubs, Indigenous Australians and aged, chronic and complex disease patients in Western Sydney are set to benefit from a new e-health project.

29 March 2011

Territory to Lead E-Health Records for Indigenous Australians

Northern Territorians will be one of the first groups of Australians to have access to e-health records thanks to a new national health reform e-health project announced on 29 March.

28 March 2011

E-Health benefits spread as Geelong team to lead roll-out

Patients are set to benefit from a better and safer medication system to be developed by a team from Geelong that has been chosen as one of nine new projects to lead the roll-out of e-health records.

28 March 2011

Tasmanian aged and palliative care to lead e-health roll-out

Aged and palliative care patients and their families in North West Tasmania will be one of the first groups of Australians to have access to e-health records thanks to a new national health reform e-health project announced on 28 March 2011.

----- End List.

This is certainly ‘bang for the buck’ for a quite small funding announcement in terms of the number of press releases!

I just love the way suddenly local members like Sid Sidebottom, Darren Cheesman, Ed Husic and Peter Garrett are spruiking the benefits of these funds to their local communities as though they are experts on the topic!

It is also fun to see how Mr Abbott gets a kicking in each release.

Most interesting is a paragraph found at the bottom of a few of the releases:

Media note:

All nine organisations were selected following a competitive process by the Department of Health and Ageing and National E-Health Transition Authority. All organisations managing these projects will now develop their final plans over the next eight weeks to ensure their work programs clearly meet national objectives before receiving final payments to implement the projects.

I only have one question. Just where can we read these ‘national objectives’ so we can all be sure that our taxpayers funds are not just vanishing into thin air. And I wonder what happens in the plans don’t pass muster!

It seems to me, reading about each of these that either we really are setting up a ‘playpen’ and that nothing more permanent will come from these pilots or we are trying to meet some ‘national objectives’ in which case there needs to be enough consistency and standardisation around what is done that the work is re-usable and replicable.

If it is to be the second - the deadlines are really too tight and there are going to be all sorts of issues around the ownership if the various software components that may be employed. From an IP sense this could get very messy indeed! Once a pilot is deemed a success how is it then procured nationally?

Enquiring minds would like to know.

Another issue is to wonder if these plans will actually see the light of day in eight weeks - with the associated objectives so we can see if they have been met?

I will take a small wager that will NOT be the case!

David.

This Really Is a Dreadful Story of Government Mismanagement. Maybe The NSW Election Result Can Help?

The following dreadful story appeared a few days ago.

Consumers 'ignored' in e-health policy, says privacy foundation

• Karen Dearne
• From: Australian IT
• March 24, 2011 7:00PM

THE Australian Privacy Foundation has accused Health Minister Nicola Roxon of reneging on her promise to consult with consumers over the design and operation of the $467 million e-health record project.

APF chair Roger Clarke said that given the advanced state of the project, with work already under way at lead implementation sites, "we are raising a necessarily urgent concern about the governance of this major initiative".

"Unless you take action right now, key decisions will be made in an unsatisfactory manner, without consumer advocacy involvement," he said in letters to Ms Roxon published on the APF website.

Mr Clarke said 20 days had lapsed since the letter was sent to Ms Roxon and 16 days after a follow-up, there was still no word from the minister.

"We seek your urgent attention to the matter, in order to avoid such an outcome. If you decline to do so, then, far from fixing the problem, you would be breaching the undertaking you gave three months ago, and endorsing the exclusion of effective consumer consultation," he wrote.

At the National e-Health Conference in Melbourne on November 30, Ms Roxon said the Health Department would "take the lead role in ensuring comprehensive stakeholder engagement across the program".

"The arrangements that we are putting in place will ensure there are robust assurance and governance provisions around the implementation of the program," the minister said.

"And yes, that governance will include consumers. We will work with all parties to ensure that a strong governance framework is in place ahead of the national system being delivered."

Dr Clarke descirbed the whole process as a "travesty".

"The National e-Health Transition Authority ran a loosely-structured roundtable in November, and three sessions in January and February," he said.

"But despite requests from participants, those events concluded without a permanent group being established. The department, meanwhile, has done nothing to ensure that the group's expertise and commitment is utilised."

Dr Clarke said the advocacy groups had deep knowledge of the needs of various categories of healthcare consumers, and the practicalities and subtleties involved in sharing medical data.

"The complexities of the health sector are so great that the general public will not get down to the devil in the details," he said. "Ongoing engagement with consumer advocates is therefore critical to the PCEHR's success."

Ms Roxon's office has declined to comment on the issues raised by the APF. Nor has the minister responded to The Australian's recent requests for further information on the consultation process.

In January, Ms Roxon promised to release a public discussion paper on the PCEHR, but this is yet to be published.

At the time NEHTA was holding the consumer reference group sessions, chief executive Peter Fleming told The Australian a consultation process was being established with the Consumers Health Forum -- now a corporate entity in receipt of government funding for a range of consultations, including the PCEHR.

Health gave the CHF a $10,000 grant to hold a members-only workshop in mid-February to work out how NEHTA should engage with consumers.

The Deloitte report on the outcomes of the Melbourne e-health conference is also yet to released - three months after the event.

More here:

http://www.theaustralian.com.au/australian-it/government/consumers-ignored-on-e-health-says-privacy-foundation/story-fn4htb9o-1226027637719

I raised this issue a while ago in this blog:

http://aushealthit.blogspot.com/2011/02/time-has-come-for-some-light-to-be.html

and essentially nothing seems to be changing.

Just why this is, is very hard to understand. I would have thought we might just have some more hope with the dramatic way in which an incumbent government has just been thrown out in NSW.

It might just be that those in DoHA and NEHTA might just realise that their political cover might be a good deal more flimsy than they had previously believed. It seems at least possible that with new directions from their political masters now being delivered to their NEHTA Board Members in NSW and Victoria we could see a demand for more accountability and transparency.

This has certainly been a mantra for the Liberal / Nationals in NSW.

If I was new Health Minister in NSW or Victoria I would be keen to ensure that what is going on in my name in NEHTA were things I was comfortable with. My view is that they should be alarmed, very alarmed at the way things are being conducted at present! If they don’t act reasonably soon they become complicit through inaction.

Proper consultation and proper transparency are vital in e-Health. They are not being delivered at present and really need to change, and fast! What has gone on with the most recent PCEHR release (Wave 2) only confirms that view to me. I hope the NSW Government is not going to pretend extending the failed HealtheLink Project as part of the PCEHR is a good idea!

On the NSW Election I see there is some e-Health comment.

e-health back in the spotlight for NSW

Telehealth technology centre at Nepean Hospital one of the first priorities for Coalition

• Georgina Swan (CIO)
• 28 March, 2011 11:51

Health services in NSW have been in limbo pending the outcome of the election, but the landslide victory by the Barry O’Farrell-led Coalition is likely to precipitate a frenzy of activity as the new government looks to implement its e-health policies.

Jillian Skinner will take on the role of Health Minister within the new government. During the election campaign, the NSW Coalition’s policies focussed on health issue prevention, openness, better management of chronic disease and increased community involvement in the running of the NSW public health system.

Now, the industry is beginning to call on the government to make good on its promises.

The world's largest health systems integrator, CSC, was quick to issue a statement welcoming the election result — and remind the new government of the Council of Australian Governments (COAG) and Federal Government’s plans for personally-controlled electronic health records.

More here:

For interest the full Health Policy is here:

https://www.nsw.liberal.org.au/policies/health

Interesting browse, as I suspect they will be around for a while!

David.

Looks Like iSoft is Really Gone!

The following appeared a few hours ago.

Dream ends for iSoft with $300m buyout

• Nabila Ahmed
• From: The Australian
• March 30, 2011 8:51AM

WHEN Gary Cohen's IBA Health agreed to buy troubled British group iSoft in 2007, he had visions of creating one of the largest healthcare information technology providers in the world.

Cohen, who was ousted last year from the company now called iSoft, is infamous for dreaming big but delivering little.

What followed was years of underperformance that has left the share price at 5c, compared with the $1.21 it closed at on the day IBA announced its agreement with iSoft, and debt of about $260 million -- more than four and a half times its current market capitalisation.

This week, the UBS-advised iSoft is poised to be bought out by the New York-listed CSC.

It's believed IT services giant CSC, which is iSoft's biggest customer, could finalise a more than $300m takeover deal for the company as early as today. ISoft is a major supplier to the British government, which is in the midst of a pound stg. 12.7 billion ($20bn) overhaul of the National Health Service's IT systems. (CSC subcontracted iSoft to carry out the work before the IBA buyout.)

More here:

http://www.theaustralian.com.au/australian-it/dream-ends-for-isoft-with-300m-buyout/story-e6frgakx-1226030527556

This sounds like the end. Banks get paid, little shareholders dudded and CSC gets a revenue stream and some OK software. Pretty typical in this sort of collapse!

At least the users will have continued support from a reasonably competent organisation that knows e-Health.

Sad loss for Australia, but it really was a rather large ask in retrospect.

David.

Are We Just Kidding About Or Serious About E-Health? Who Knows. It Seems We Are Building a Playpen!

The following appeared in today’s Age On-Line. The paragraph in bold says it all!

Electronic health records planned

Kate Hagan

March 30, 2011

UP TO half a million patients, including the chronically ill, will be the first to receive electronic health records under Labor's radical plan to overhaul the way medical data is kept.

Federal Health Minister Nicola Roxon yesterday announced $55 million for nine projects, to be run by various groups including pharmacists, general practitioners and hospitals.

.....

The federal government's clinical adviser on e-health, Dr Mukesh Haikerwal, described the projects as "a playpen to see how these things could work".

Full article here:

http://www.theage.com.au/national/electronic-health-records-planned-20110329-1cexj.html

I am just awed that half a billion dollars can be spent on a “playpen”.

There are plenty of examples overseas about what works - a playpen is not needed. Some competence, leadership and governance are!

David.

Ms Roxon Has Just Administered A Severe Shotgun Wound To Her Very Own Foot!

We have just has the announcement of the additional Wave 2 Personally Controlled EHR Sites Announced.

There is coverage here:

Nine new e-health pilots, but doubts linger

• By Michael Woodhead on 29 March 2011
• 0 comments

A further nine new e-health pilot sites and projects have been announced (link) by health minister Nicola Roxon, who says they will bring the personally controlled e-health record a step closer to reality.

The new pilot sites include GP divisions and hospitals, with Brisbane becoming an ‘e-health super site’, as most of the citiy’s divisions and the Mater Hospital involved, the minister says.

“Our 12 e-health lead implementation sites are aiming to have more than half a million Australians enrolled before the national launch of e-health records next year,” Ms Roxon said.

Medibank Private will also be involved in the pilot scheme, with a portal that allows members with chronic diseases to enter data into a ‘Health Book’ that will be shared with health providers. Medibank’s e-health project will also offer electronic health management plans, test results and appointment reminders.

More here:

And here already.

DoHA announces second wave e-health sites

The latest nine sites include maternity at the Mater Hospital, sites in North and South Brisbane and sites across NT, SA and the ACT

• Chloe Herrick (Computerworld)
• 29 March, 2011 12:42

The Department of Health and Ageing (DoHA) has unveiled the second wave of e-health implementation sites to deploy and trial specific aspects of the Gillard Government’s $466.7 million personally controlled electronic health records (PCEHR) initiative.

Minister for Health and Ageing, Nicola Roxon, said the announced e-health implementation sites, to join the initial three sites in Brisbane, the Hunter Valley and Melbourne East, was the next step in the Federal Government’s health reform project.

“In these nine projects we can see practical examples of how e-health can improve heath care for patients,” Roxon said in a statement.

The announced sites, include both North and South Brisbane and the maternity unit at the Mater Hospital, as well as sites across the Northern Territory, South Australia and the ACT. The sites will receive a share of $55 million from the project for implementation.

Each site will focus on a particular demographic identified as a high priority for e-health records. Those in the Northern Territory, Western Australia and South Australian will focus on indigenous populations, chronic disease patients will be the focus in western Sydney while the aged care and palliative care patients will become priority at those sites in NSW, the ACT and Tasmania.

“With more than 90 applications received, it’s clear there is a high level of support for e-health," Roxon said.

According to Roxon, the total 12 e-health sites will be aiming to have in excess of half a million Australian enrolled before the national launch of the electronic health records on 1 July 2012.

More here:

http://www.cio.com.au/article/381341/doha_announes_second_wave_e-health_sites/

The full list of sites and the technologies is found on the blog here:

http://aushealthit.blogspot.com/2011/03/wave-2-sites-for-pcehr-program-here-is.html

Or at the first link above.

Why is this all just an utter fiasco? It is easy.

After careful checking with a range of NEHTA insiders and sources it is now clear a national integration architecture and strategy does not exist.

Worse some sources have suggested that NEHTA has a consultant working away on a ‘Standards Gap Analysis’ due in May which will be a first step towards working out how these pilots - which by then are meant to have developed their implementation plans - are to be forged into a coherent national system.

Anyone with any clue knows that all this work has to be done first - and not as an afterthought.

I challenge NEHTA and DoHA to show I am wrong by releasing the already developed plans that are going to result in any form of coherent national PCEHR system. They won’t and can’t because they simply does not exist.

Half a billion dollars will go largely down the gurgler as these idiots utterly fail to get even the basics of large project delivery 101 right.

This will see the Minister lose her portfolio when the public realises just how badly this has been done and how political deadlines have utterly overwhelmed common sense.

Not only is the design of the PCEHR a disaster but this will now be compounded by implementation of island like pilots which will really struggle to ever talk to each other.

Just amazing! Incompetence on this scale just defies belief.

David.

Wave 2 Sites For the PCEHR Program - Here is the List for the Information of Readers.

The following popped up a little while ago.

Nine organisations have been selected to develop a Project Implementation Plan to run a second-wave site:

• Medibank Private Limited Project will implement a consumer-oriented portal, which integrates consumer entered information into a ‘Health Book’. The ‘Health Book’ will be initially made available to all Medibank Private customers and their healthcare providers enrolled in Medibank’s Health Management and Chronic Disease Management programs. Medibank Private will not be using any of this information for the management of claims or eligibility for health care insurance benefits.
• Brisbane South Division Limited Project will deliver a substantial eHealth site in one of Australia’s major capital cities. The project will aim at enrolling up to 25,000 individuals in the Brisbane and Ipswich region. A key focus will be on individuals with disabilities and their carers, war veterans and war widows, and children commencing school. The project will bring two Division’s of General Practice onboard, Brisbane South and Ipswich and West Moreton, and public and private hospitals, allied health and GP’s. The project will leverage wave 1 infrastructure.
• Mater Misericordiae Health Project will deliver an eHealth site to enhance healthcare for mothers and newborns. The population reach of the project is 9000 mothers and involves three GP Divisions (South East Alliance, Brisbane South and the South East Primary HealthCare network), local specialist obstetricians and a software vendor InterSystems. The project will leverage wave 1 infrastructure.
• Northern Territory Department of Health and Families Project will deliver a lead eHealth site for Indigenous Australians living in the Northern Territory, South Australia and Western Australia. The project will leverage the existing NT shared electronic health record and extend the existing service to all Northern Territory residents and Indigenous individuals in Western Australia and South Australia.
• Greater Western Sydney eHealth Consortium (NSW Department of Health) Project will implement key building blocks for state-wide eHealth infrastructure that will allow NSW Health to connect to the PCEHR System when it becomes available. The initial focus will be on priority consumer groups in the Greater Western Sydney region. The project includes four GP Divisions (WentWest, Nepean, Blue Mountains and Hawkesbury-Hills) and will leverage previous technology investments. With a population reach of 1,750,000, the project will be able to expand the entire solution quickly to encompass a significant geographic area and ultimately the whole of NSW.
• Cradle Coast, North-West Area Health Service Project will provide end of life policy lessons for the PCEHR System. The project targets aged and palliative care patients and their families, palliative care medical specialists and clinical nurse consultants. The project will use off-the-shelf care planning software to share the advance care directives until the national PCEHR infrastructure is in place.
• St Vincent’s and Mater Health Sydney Project will establish a lead eHealth site based around St Vincent’s and Mater Health Sydney, in conjunction with partnering Divisions of General Practice, participating specialists and software vendors including Smart Health, Precedence, HCN and Best Practice. The project has a population reach of 1 million individuals attending the St Vincent’s campus and aims to improve clinical communication across the project’s footprint through the delivery of key PCEHR components.\
• FRED IT Group MedView Project will demonstrate the ability for up to 2 million individuals and their healthcare providers to access their prescribing and dispensing history via a medicines repository using national electronic prescription and other standards. The project will deploy MedView to all pharmacies and GPs in the Geelong region and to a further 10% of this target market nationally. The project will bring together a grouping of private sector eHealth vendors including FRED, eRx, Best Practice, Zedmed, iCare, Microsoft and SIMPL.
• Calvary Healthcare Project will support a cross-border population of approximately 800,000 individuals in the ACT and regional NSW by bringing together a major grouping of private sector eHealth vendors. The vendors involved include iSoft, HCN, HealthLink, Smart Health Solutions and Precedence HealthCare.

The second-wave sites will develop their plans by the end of May 2011 to ensure their work programs meet national objectives.

The eHealth sites program is being managed overall by NEHTA, under contract to the federal Department of Health and Ageing.

The full page is here:

http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/eHealth-sites-factsheet

Comments welcome!

David.

Rumour Central: Wave 2 PCEHR Projects Apparently To Be Announced Tomorrow!

The rumour goes that Health Minister Roxon will dig herself into a deeper hole tomorrow when she announces those who have had the misfortune to win Wave 2 projects in the PCEHR program.

More waste seems to be inevitable and no apparent release yet of the Concept of Operations for the project means it will be hard to know who is doing what with whom.

A leadership, governance and financial mess seems pretty likely to me if the approach is not radically re-designed. We will all know in just over a year, and hopefully much sooner if there is any hope or not!

David.

AusHealthIT Poll Number 63 – Results – 28 March, 2011.

The question was:

What Score Would You Give NEHTA / DoHA for their Efforts so far in Explaining The PCEHR Program to Affected Clinicians?

The answers were as follows:

10/10

- 5 (13%)

7.5/10

- 2 (5%)

5/10

- 2 (5%)

2.5/20

- 7 (19%)

0/10

- 20 (55%)

Well that is seems pretty clear with only 23% giving them a score of 5 or above! Clearly any money spent on clinician communications has been wasted!

Votes : 36

Again, many thanks to those that voted!

David.