Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Friday, July 11, 2014

The Risks Of Health IT Are Coming Up More And More Regularly. Where There Is Smoke There Is Fire!

This appeared a little while ago.

Electronic Health Records: First, Do No Harm?

6/26/2014 09:06 AM
EHRs are commonly promoted as boosting patient safety, but are we all being fooled? InformationWeek Radio investigates.
One of the top stated goals of the federal Meaningful Use program encouraging adoption of electronic health records (EHR) technology is to improve patient safety. But is there really a cause-and-effect relationship between digitizing health records and reducing medical errors? Poorly implemented health information technology can also introduce new errors, whether from scrambled data or confusing user interfaces, sometimes causing harm to flesh-and-blood patients.
This is the issue we will tackle in our InformationWeek Radio show, Is Digitizing Healthcare Making It Less Safe?, Tuesday, July 1, at 2 p.m. EST. My guest for the show will be Scot M. Silverstein, M.D., a consultant and professor in the Drexel University informatics program who researches the shortcomings of EHR software. He also tracks the literature on EHR risks and offers his interpretations on the Health Care Renewal blog, where he posts as InformaticsMD. Silverstein serves as an expert witness in cases involving malfunctioning EHRs or malpractice cases involving the reliability of evidence recorded in EHR systems.
Don't expect a simple answer to the question of whether digitization is making healthcare more or less safe, on balance. "People will say, it's got to be better than paper," Silverstein said, in an interview in advance of the radio show. The inherent superiority of digital data tracking winds up being more an article of faith than a solid argument, he said. After all, digital systems can also make mistakes on a much larger scale than mere humans. He points to a case in 2011 where a glitch in the digital prescription system used at Rhode Island's Lifespan health system caused thousands of patients to receive the wrong form of certain medications, simply because the system dropped a suffix for "long acting."
Health IT may be preventing errors, too. Ideally, a comprehensive digital health record would be indexed and searchable to prevent the sort of errors associated with not knowing a patient's medical history or allergies, with automated alerts to warn of undesirable drug interactions and otherwise prevent medical errors before they can happen. That's the future health IT advocates are working toward.
As an informaticist, Silverstein believes in the potential of health IT but adds, "I've been working really hard to promote the elimination of bad health IT from the marketplace." Meanwhile he takes issue with the categorically inflated claims about the benefits of EHRs, which are often treated as self-evident. In one recent post, he observed that federal health officials essentially had to eat their words when challenged to produce evidence. When the American Association for Physicians and Surgeons filed a Freedom of Information Act request for research supporting claims of the of the lifesaving importance of adopting EHR technology, the response that came back was this: "While our Office of E-Health Standards and Services works to implement the provisions of the [American Recovery and Reinvestment Act], we do not have any information that supports or refutes claims that a broader adoption of EHRs can save lives."
Lots more here:
Also we have seen this recently.

It's time to redesign EHRs to improve patient safety

June 26, 2014 | By Marla Durben Hirsch
Providers have been lashing out against subpar electronic health record design for years. They gripe that not only do poorly designed systems impede workflow and cost too much, they also create new patient safety problems and don't share data with other systems to coordinate care, as promised. Still, the industry hasn't done much to address these concerns.
However, maybe now they'll have to. New evidence released this week bolsters what the providers have been saying all along: EHRs, as currently designed, adversely impact patient safety.
First, there's the new study of adverse patient safety events at the Veterans Affairs Department (VA), which operates a voluntary, non-punitive reporting program of such incidents. Three-fourths of the 100 EHR-patient safety issues studied related to design issues. Moreover, a whopping 94 percent of the safety concerns were traced back to just four problems, all of them design flaws, including:
  • Unmet data display needs, such as small print or a "poor fit" between information needs and the clinician's task on hand
  • Problems with software upgrades and modifications, which created configuration errors
  • System-to-system interface problems
  • "Hidden dependencies" within the EHR, such as use of matching algorithms that created errors and delays.
Lots more here:
And here are a whole lot of relevant links:
Related Articles:
There is increasingly concern to work out how best we can address these issues in a systematic way. The first thing to do is to recognise there is a series of problems and complexities that need to be addressed.
I wonder will we see any worthwhile contribution for Australian regulators DoHA and NEHTA. I will wait and watch. We need to be very clear there is both good and bad e-Health and we do need to avoid the latter!
David.

Thursday, July 10, 2014

Review Of The Ongoing Post - Budget Controversy 10th July 2014. It Is Sure Going On and On!

Budget Night was on Tuesday 13th May, 2014 and the fuss has still not settled by a long shot.
Here are some of the more interesting articles I have spotted this seventh week since it was released.
It was interesting to see the AMA President continue come out so strongly against the co-payment. Does not bode well for success in the Senate when it changes on July 1. The level of comment on this issue is also seemingly unending.
Listening to the political conversation last week it seems like very little of the Government’s agenda has an assured passage through the Senate any time soon!
What we are also seeing is DoH and indeed much of the Government flailing about - quite unclear on a number of fronts just what is coming next. Every day it seems to look more like a chook raffle! The first headline below says it all! Best I have seen in a good while.
We sure do live in interesting times!
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General.

Govt 'charm' will get budget passed: Pyne

  • July 04, 2014 10:12AM
CHARM - that's how the Abbott government will get its controversial budget through the new Senate.
EDUCATION Minister Christopher Pyne reckons the government will get its agenda passed despite the concerns of key crossbenchers.
"I'm quietly confident that given the charm of members of the government - and the obvious excellence of our program - that we will get most of our program through," Mr Pyne told the Nine Network on Friday.
The government needs the votes of six out of eight crossbenchers, with the Palmer United Party's voting bloc of four key to success.
Negotiations with the new senators have begun in earnest as they prepare to take up their seats in the upper house on Monday.
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Tony Abbott and his fading $25 billion sales pitch

Phillip Coorey
Outside the Senate entrance on Friday morning in sub-zero temperatures, Palmer United Party Senator Dio Wang found himself being grilled over the big issue. Did he, too, think Tony Abbott was a psychopath?
“Not my choice of words,” said Wang, or words to that effect as he politely dissociated himself with the rambling attack on the Prime Minister the day before by his PUP colleague, Jacqui Lambie. Wang, like Lambie, has not yet met the Prime Minister. Unlike Lambie, he will reserve his judgement until then.
Welcome to the new Parliament and the issues commanding its initial focus. Goodness knows what the Prime Minister must be thinking about the task ahead, which begins in earnest next week when his agenda and the nation become hostage to the new Senate and its myriad characters who, Coalition Senate leader Eric Abetz pointed out this week, were “all God’s children”.
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Tony Abbott's changes to universities and health 'a crime, absurd', says Nobel Prize winning economist Joseph Stiglitz

Date July 3, 2014

Peter Martin

Economics Editor, The Age

The government's plan to deregulate universities is "a crime" and the move for co-payments for medical services is "absurd" in the view of visiting Nobel prize-winning economist Joseph Stiglitz.
Asked by Fairfax Media to nominate the two biggest mistakes the government could make that would take it down the American path of widening inequality and economic stagnation, Professor Stiglitz chose the budget changes to university fees and Medicare. Each would make Australia more like the US.
"Countries that imitate the American model are kidding themselves," he said. "It seems that some people here would like to emulate the American model. I don't fully understand the logic."
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Former World Bank economist says Medicare reforms ‘absurd’

3rd Jul 2014
NOBEL prize winning economist Joseph Stiglitz has slammed as "absurd" the Abbott government's health reforms, saying they would take Australia down the American path of widening economic inequality and stagnant growth.
Professor Stiglitz said budget changes to Medicare, including the planned introduction of a $7 co-payment, were the biggest mistakes the government could make along with the plan to deregulate university fees. 
Warning that the government should not crib its policy directions from the US, he praised the Australian health system. 
"Your outcome per dollar is probably the best or one of the best. Your equality of access is one of the best," said Professor Stiglitz, who is in Australia on a speaking tour. "Why would anybody… try to make your system like the American system? The US is at the bottom," he told the Sydney Morning Herald
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Health report card reveals excellent grades

Date July 1, 2014

Ross Gittins

It’s good news week. There are lots of bad things happening in the world and journalists regard it as their job to dig them out and wave them in front of your face. No piece of disheartening news should go unreported.
But good things are happening, too. And I often think people would enjoy reading the news more if we didn’t ignore so many of them.
One of the main jobs of the federal government’s Australian Institute of Health and Welfare is to produce a report card on the state of Australia’s Health every two years. The latest edition is just out and it’s crammed with good news.
Perhaps our most basic desire is to delay our death, and on this score we’re doing particularly well. "Australians have one of the highest life expectancies in the world and can expect to live about 25 years longer, on average, than a century ago," the institute says.
In 1910, a baby boy could expect to live for 55 years and a baby girl 59 years. Today it’s 80 and 84. That puts us sixth highest on the world league table for boys and seventh for girls, but the countries coming top – Iceland and Japan – beat us by less than two years. And we leave the Yanks for dust.
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Labor says Federal Budget is “concerning” for HIV sector

Shadow Health Minister tells the Star Observer there is “nervousness” in the HIV sector over possible funding cuts.
HIV prevention efforts could be hampered by the introduction of the new $7 GP co-payment and funding cuts in the recent Federal Budget, Shadow Health Minister Catherine King has told the Star Observer.
The Labor health chief’s comments follow a meeting in Sydney with a number of groups including health body ACON, the Australian Federation of AIDS Organisations (AFAO), the National Association of People With HIV Australia and Organisation Intersex International.
“I think it’s really concerning,” said King.
“The GP tax will have a significant effect on the community both in terms of access to general practice, in terms of keeping people well but also on prevention and making sure that we continue down the pathway of reducing incidence of HIV.
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Private health insurance carrot feels more like a stick

Date June 28, 2014

Colin Cosier

Video journalist

When I turn 31 this week I’ll join a group of Australians who will be financially penalised for not having private health insurance. I’m not alone. Just more than half of all Australians are not insured.
I’m not covered because I don’t earn enough money to justify the premium and I don’t need it because I’m already covered under our perfectly adequate public health system, Medicare.
But, as a 1983 vintage, I’m about to cross the government’s starting line for the Lifetime Health Cover initiative.
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Health Department Moves.

Subsidy for diagnostic HbA1c moves closer

30 June, 2014 Melissa Davey
The final hurdle is in sight for government-funded diagnostic HbA1c testing for diabetes, with Federal Health Minister Peter Dutton considering a recommendation that the test be listed on the MBS.
The Medical Services Advisory Committee, the gatekeeper to the MBS, recommended HbA1c be funded for diagnosis of diabetes earlier this year.
Dr Graham Jones, spokesman for the Royal College of Pathologists of Australasia, said the college was strongly requesting funding approval for diagnostic HbA1c testing, in order to bring Australia in line with international recommendations.
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Funding for nurses in GP surgeries threatened by ruling

By SAM RIGNEY

July 2, 2014, 10:38 p.m.
CHANGES to multidisciplinary care in GP surgeries will place even more strain on the region's 650 overworked doctors, according to the Hunter's primary healthcare body.
Hunter Medicare Local said its members had raised concerns over a new Department of Health ruling which says nurses can no longer have the time they spend contributing to health assessments claimed under the Medicare Benefits Schedule.
Traditionally the time nurses spent on the assessments would be added to the GP's time when deciding whether to bill for a brief, standard, long or prolonged consultation.
Hunter Medicare Local board member and GP Dr Milton Sales said those patients were typically bulk billed, meaning the nurse's activity would become unfunded.
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Govt backflip on MBS claiming for nurses

3rd Jul 2014
THE government has swiftly scrapped a policy to disallow Medicare rebates for practice nurses who perform health assessments, only days after it was revealed.
The backflip came in response to a storm of protest by doctors, nurses and practice managers after the position was revealed on an obscure Medicare website on Monday.

GPs and managers were outraged, saying they would have to dismiss practice nurses who played a key part in their business plans and warning the move would have a serious impact on community health, especially for the elderly.
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Medicare backflips in GP nurse saga

3 July, 2014 Paul Smith
The looming GP nursing crisis has been averted after Medicare appears to have binned it is warning to doctors they cannot include nurse time when claiming MBS health assessments.
The warning was issued by Medicare on Monday but has now mysteriously been disappeared.
It declared that Medicare had been offering the "incorrect" advice to doctors over the last four years on the use of the items which underpin the Healthy Kids Checks and assessments for refugees, elderly patients and those at high risk of chronic disease.
The time nurses spent on the health assessments could not, as previously suggested, be added to the doctor's time in calculating which item to claim. 
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Pharmacy.

Consumers hoodwinked by supermarket pharmacist ploy: Guild

30 June, 2014 Chris Brooker
Concerns about supermarket encroachment into healthcare have been ignited by pictures of what may be a pharmacist working in a retail outlet, part of an attempt to “hoodwink consumers”, the Pharmacy Guild of Australia believes.
The pictures (one of which is attached) show a person in a white coat standing in a supermarket aisle. They were described by the Guild as a “disturbing development” and as part of a plan to convince consumers they are receiving professional healthcare advice in supermarkets.
The photographs follow recent advertisements on employment website Seek.com by consumer engagement company, XPO Brands, looking for health professionals.
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Woolworths ‘health check’ scheme slammed

1st Jul 2014
DOCTORS and pharmacists are up in arms over Woolworths’ scheme to offer health checks in supermarkets by trainee chemists and nurses.
AMA president Associate Professor Brian Owler said the supermarket giant should drop a scheme to have graduating pharmacists and entry-level nurses conduct blood pressure and cholesterol tests for shoppers.
Professor Owler said the checks would encourage shoppers to think they could skip seeing their doctor.
“This is a dangerous idea that must be stopped before it gets off the ground,” he said.
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The Royal Australian College of General Practitioners call for Woolworths to scrap health checks

  • PerthNow
  • July 02, 2014 4:41PM
Royal Australian College of General Practitioners president Liz Marles.
ONE of the country’s top doctors’ groups has called for the immediate scrapping of a plan to introduce health checks to supermarkets.
Nurses have been performing free blood pressure and cholesterol checks at nine Woolworths supermarkets since October.
Woolworths said yesterday it would review the trial extensively before expanding the service to more stores.
The Royal Australian College of General Practitioners today joined the growing chorus of critics of a plan to introduce health checks to supermarkets, calling for the program to be scrapped.
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Pharmacy groups fight over supermarket plans

3 July, 2014 Chris Brooker
A war of words has erupted between two pharmacy representative groups in the wake of the Woolworths' pharmacists in supermarkets saga.
Following the retail giants belated denial that it was responsible for advertisements calling for pharmacy students and graduates to conduct “health checks”, the Pharmacy Guild of Australia and Professional Pharmacists Australia are now in conflict over the union’s purported support of Woolworths.
In a release on Tuesday, Professional Pharmacists Australia said it “welcomed the introduction of Woolworths’ program” where pharmacists perform basic health checks in supermarkets, saying it “provided an alternative employment pathway for young pharmacists and could improve health outcomes for the community”.
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Guild argues against corporate pharmacy model

3 July, 2014 Chris Brooker
Deregulation of the Australian pharmacy sector would lead to the proliferation of “corporate” models of practice, the Pharmacy Guild of Australia believes. 
In its submission to the Federal Government’s national competition policy review, the Guild says this high volume/low margin approach would focus on profitability and maximising shareholder value at the expense of independent community pharmacies.
“This model is particularly unsuitable to the practice of pharmacy because the need to decrease costs would put pressure on less profitable parts of pharmacy practice, in particular levels of professional care and ensuring that all Australians continue to have equitable and timely access to the full range of scheduled medicines,” said Guild executive director, David Quilty, writing in Guild newsletter, Forefront.
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Pharmacists not entitled to reimbursement: economist

4 July, 2014 Chris Brooker
Australian pharmacists do not have a “special entitlement” to taxpayer funds to ensure their profitability, says a health economist who is calling for a Productivity Commission review of the sector.
In an editorial in Australian Prescriber, Professor Philip Clarke of the Centre for Health Policy Program and Economics at the University of Melbourne, a well-known critic of the current pharmacy model, dismisses Pharmacy Guild calls for price disclosure compensation.
“If the government compensates pharmacists for more rapidly declining generic prices, should it not also compensate firms that sell computers or mobile phones, as they also face declining profit margins from falling prices?” 
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2 July 2014, 8.20pm AEST

Turf war? Woolies' health checks fuss not just about patients

Wendy Lipworth

Senior Research Fellow, Bioethics at University of Sydney
When supermarket chain Woolworths announced plans to offer in-store “health checks” earlier this week, health groups came out in force to criticise the move. But scratch the surface and it’s apparent that the criticisms aren’t just about protecting the public.
The checks, which have been pitched by Woolworths as a service for their customers, will see final year pharmacy students, graduating pharmacists, and nurses measuring blood pressure and cholesterol, among other things.
Professional health groups, the Pharmacy Guild and the Australian Medical Association (AMA) have reacted negatively. AMA president Brian Owler has described the proposal as:
“a dangerous idea that should be stopped before it gets off the ground.”
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Medicare Local Impacts.

Health leadership concern

By GABRIEL WINGATE-PEARSE
June 30, 2014, 10:53 p.m.
THE Hunter has a battle on its hands to keep local control over vital health services.
And health professionals fear that without the right mix of experience and expertise, Hunter Medicare Local will lose its bid to become a player in the federal government's soon-to-be unleashed "primary health network".
That would open the door to private health insurers such as Medibank Private or BUPA to take over primary healthcare services in the region.
It is widely agreed that would be the death knell for the highly prized GP Access After Hours service, and other valued services run by Hunter Medicare Local, which has a reach of 750,000 people and employs 300 staff.
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Medicare local seeks advice

By HANNAH KNIGHT
June 29, 2014, 2:52 p.m.
LODDON Mallee Murray Medicare Local has appointed Dr Ewa Piejko as a medical adviser to the organisation. 
Dr Piejko is a general practitioner in Strathfieldsaye and holds an Adjunct Associate Professor position with the Monash University School of Rural Health.
"My role as a medical adviser is really about providing some information and some practical application of how some of the projects and programs the medicare local wants to deliver for patients and how that translates into general practice," Dr Piejko said.
"So it's addressing things like how we can make some of the programs the government is rolling out more accessible to patients through general practice.
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Last day for Medicare Locals body

30th Jun 2014
THE dismantling of Labor’s regional primary care experiment has begun, with the peak body for the nation’s 61 Medicare Locals closing down after a bare two years of operation.
The Australian Medicare Local Alliance was given only about seven weeks to pack up by today’s deadline, after it was scrapped in the May budget with the loss of some 60 jobs.  
In his parting message, AML Alliance chair Dr Arn Sprogis said the existing network of Medicare Locals would be “essential and central”  to realise the government’s vision for primary healthcare through a new system of Primary Health Networks (PHNs).
“The organisational and human capital, skills and innovation embedded in existing Medicare Locals is a critical component for a successful PHN rollout, and AML Alliance has played a key role in making this possible,” he said.
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King calls on Capricornia MP to make stand on Medicare Local

2nd Jul 2014 2:39 PM
SHADOW Health minister Catherine King today called on the Member for Capricornia to stand up for the region's Medicare Local service.
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Comment:
It seems the fuss is not yet settled - to say the least. Will be fascinating to see how all this plays out.
The crucial New Senate is sitting for the next 2 weeks so anything may happen!
To remind readers there is also a great deal of useful health discussion here from The Conversation.
Also a huge section on the overall budget found here:
Enjoy.
David.

Wednesday, July 09, 2014

If Managed Well It Looks Like The Opt-Out Approach For Shared Electronic Record Can Work.

This appeared a little while ago.

SCR reaches 40m patients

2 July 2014   Sam Sachdeva
The NHS Summary Care Record has hit the 40m patient mark, just over a year after low usage rates led to calls for it to be scrapped.
NHS England says it is “delighted” by the milestone, and is now focussing on rolling out the SCR in A&E, NHS 111, and GP out-of-hours services.
The SCR was one of the key projects of the National Programme for IT in the NHS.
It was intended to create the 'national' element of an integrated care records service that was otherwise to be delivered by the roll-out of detailed care record systems at trusts.
…..
The SCR was eventually given the go-head by the present government on an opt-out basis.
The record provides a core set of required clinical data, including allergies, medications and adverse reactions, pulled from GP systems, which can be viewed by health professionals involved in a patient’s care.
…..
While the 40m mark is a significant milestone, usage rates for the SCR have been a concern throughout its history.
Figures released in February last year revealed that while there were more than 22m records in existence at the time, they had been viewed just 240,000 times.
This led to some calls for the programme to be scrapped. However, by the end of the year, NHS England was reporting that SCR usage rates among clinicians had risen to an all-time high of 12,000 views a week.
The HSCIC told EHI that the SCR now gets 19,000 views a week and that the number continues to grow.
GP practices will be required to provide an automated upload of their summary information to the SCR, or have published plans in place to achieve this, by 31 March 2015.
…..
Full article is here:
What we have had here is a gradual approach with proven infrastructure and a decision to keep the shared record as simple as possible - so it met the desired purpose of providing basic key information when it was needed in emergency rooms etc.
It has eventually worked, I believe, because it has not fallen into the trap of excess complexity and detail which added very little value and which made the system unwieldy. Pity those driving the PCEHR did not follow a similar approach. What was happening in the UK was well known well before the PCEHR was designed. Technical overreach is how I would describe what DoH and NEHTA were guilty of!
David.

Tuesday, July 08, 2014

Sometimes The Headline Does Not Quite Reflect What The Article Actually Says!

This appeared last week:

Hambleton gains industry’s approval

THE appointment of Steve Hambleton as chairman of the ­National E-Health Transition Authority has been welcomed by the industry, which hopes for an overhaul of the agency that delivered the troubled $1 billion personally controlled e-health records system.
Dr Hambleton, immediate past president of the Australian Medical Association, replaces David Gonski, who completed the maximum two terms, or six years, as NEHTA chair.
Dr Hambleton was a panel member on the government review into the PCEHR.
The Consumers e-Health Alliance said it was interesting to contemplate the role Dr Hambleton needed to play as incoming chair of NEHTA.
CeHA is an unincorporated, not-for-profit organisation that counts chronic illnesses, disabilities and carer organisations as partners. They include Alzheimer’s Australia, Aged Care Association of NSW, Arthritis Australia, Leukaemia Foundation of Australia, Heart Foundation and Stroke Foundation.
“Dr Hambleton participated in the Gang of Three which reviewed the PCEHR and produced 38 recommendations,” CeHA convener Peter Brown said.
“The government has not yet decided what to do about them, but Dr Hambleton’s appointment, and his acceptance … it would be odd if these recommendations were not to be adopted in some agreed way.”
Mr Brown said comments by NEHTA that Mr Gonski was “responsible for revitalising its board, and galvanising co-operation between the governments of Australia to deliver urgently needed infrastructure and standards for health information” were inaccurate. “Neither of these claims are supported by evidence. I’d suggest they are based on misinformation,” he said.
“I don’t believe Mr Gonski would support such claims. I have no doubt he tried hard, but it would not have been possible to revitalise the NEHTA board as by its very nature it was inadequately equipped to do its allotted job.”
Mr Brown said the NEHTA chair had no control over the composition of its board, whose members are mandated to comprise representatives of federal, state and territory governments who provide its equity funding with each appointing a board member.
“The appointees, in the event, were the chief executives of each government’s health entity, none of whom were likely to possess the required experience, and in any case were likely to be ­replaced with each cabinet ­reshuffle, entity restructure or change of government,” he said.
Lots more here:
What I found very interesting here was the view that essentially the previous Chairman had essentially failed and that there was little chance of change into the future - without the dissolution of NEHTA which puts Dr Hambleton out of a job. Does that mean he will have a role in the new structure?
It is also of interest that it is not NEHTA but rather the Department of Health that owns - with Human Services operating - the PCEHR. Just what influence NEHTA has had in recent times on the PCEHR seems to have been rather constrained.
I just get the feeling there is a bit of woolly thinking about how e-Health governance is now operating - and with the lack of clarity as to what the future looks like until we see the much delayed response to the PCEHR Review.
David.