To those of us in the Health IT community who genuinely care about health sector reform and the ongoing sustainability of our health services, it seems that we will need to get mobilised in order to try to change the directions that NEHTA is taking.
Before expanding on why I think this is so let me first say that I would really like NEHTA to succeed, but their approach however is, I believe, setting them up for failure before they start. A big call? I don’t think so, not after having been involved in and observed large scale Health IT implementations from all over the world for over 20 years.
How do you make a program like the one NEHTA plans fail? The things you do are as follows:
1. You don’t have a well considered, fully stakeholder consulted and clearly articulated program plan.
2. You don’t have a publicly persuasive and credible and robust business case supporting your plan.
3. You avoid detailed consultation with stakeholders, such as the software industry, on the impact of your activities so they are unsure of just what is happening and why?
4. You imagine grass roots clinicians (doctors, nurses and ancillary providers) will just accept what you offer when you choose to offer it.
5. You don’t have a well developed and open communication strategy that anticipates the information needs of your stakeholders.
6. You take advice from sources who are so unsure of their ground they seek anonymity.
7. You ignore, or redo, the work which was previously well done.
8. You have your implementation organisation operate with a culture of secrecy and non-disclosure.
9. You provide no clear outcome based indications of what will be achieved and by when.
10. You ensure the survival of the implementation organisation (NEHTA) by pursuing a non-transparent, complex, failure prone long term vision (if one actually exists), at the expense of the clear needs of the health system, which is to have decisive and doable projects undertaken promptly and focussed on assisting health care delivery.
The lessons of history are that clinical systems initiatives have never worked if the workers at the coal face - the doctors and nurses - are not convinced and keen to adopt.
I leave it as an exercise for the reader to work out how much NEHTA is doing right. My guess is that if even three of the above are not addressed, let alone ten, NEHTA will fail.
How many points do you think NEHTA has right on its present course?
David.
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