An article by Julian Bajkowski of The Australian Financial Review on the 28th Nov 2006 suggests that the AMA is seeking to have Health Minister Tony Abbott to create legally enforceable standards that govern the sale and use of electronic health systems.
Quoting an AMA position paper obtained by The Australian Financial Review we are told that medical practitioners remain deeply concerned about various state electronic health initiatives. We are also told the AMA fears the plans, if not properly governed, will recreate rail gauge incompatibilities - various state health systems will be unable to share critical patient data at a clinical level.
This will come as no shock to any reader of this blog who will be aware that for the last eight months I have been suggesting there is a critical pressing need for the development of a consensus based National E-Health Plan, Business Case and Implementation Plan. The AMA is dead right that nationally E-Health is in one serious hole and urgent action is required to correct the situation.
As my manifesto of last Friday made clear I hope we can lift from the present rather messy base. To quote
“My view is that right now there is a lot of unfocussed, uncoordinated activity going on (some good and some bad) and that it is the time to take a step back, work out, at a national level, what is needed and how best to get there. As a nation in 2000/1 we had some good ideas with HealthConnect but we then lost the plot and momentum by early 2005. We can’t afford another wasted four years.
In the blog I hope to alert and warn where I see mistakes being made and lessons we should already have learnt being repeated. Hopefully the assumptions above will point to those things which need to be assured before investments are made.
Overall I am hoping to foster the change from a heard of cats to a sleek shoal of fish all swimming towards real, practical and achievable goals.”
The article also goes on to say – as its second main point – that the continuing funding of NEHTA beyond 2008/09 is now under review by the Health Minister. This review is timely as NEHTA has now been operational for a decent period. As I stated previously “My view is that unless there are some really useful and practical outcomes within the next six months (i.e. NEHTA having been in action for just on three years (Authorised by COAG July 2004) serious questions will start being asked. The opportunity cost of all this inactivity is really astronomical in terms of patient suffering and lives lost.”
Before continuing funding there are a number of questions I suggest Mr Abbot should ask:
1. Has NEHTA developed and articulated the consensus based National E-Health Plan, Business Case and Implementation Plan which is needed to frame all other E-Health activity and investment? If not, why not?
2. With the effective gutting of both the E-Health Implementation Branch of DoHA and the Australian Health Information Council (AHIC) should NEHTA have been more aware of the strategic gap at the core of Australian E-Health an moved promptly to address this gap?
3. Have NEHTA’s interventions and work products contributed positively to the development of the E-Health industry in Australia through the provision of clear, usable advice and technical frameworks?
4. Have clinical users of E-Health system seen a perceptible improvement in the quality and availability of satisfactory systems which interoperate and also allow for the smooth and reliable communication of clinical information?
5. Has the agenda of improving Clinical Decision Support within E-Health Systems to assist with the quality and safety of patient care seen a significant advance since NEHTA’s inception?
6. Has access to critical clinical information in life-saving and emergent situations been improved in the last 2-3 years under NEHTA’s guidance?
7. Is the present governance of NEHTA with a CEO level board and advisory committees whose membership is not made public the right way to manage a critical national effort such as the National E-Health Agenda?
8. Has NEHTA’s cross jurisdictional nature lead to a much improved alignment of the E-Health initiatives in each of the States and Territories?
9. Are the stakeholders who are involved in the delivery of E-Health products and services finding it easier or harder to make progress with NEHTA’s presence in the arena?
10. Is the value obtained for the investment in NEHTA becoming clear to the extent that funding should be continued or is a major strategic re-assessment required?
11. Should Australia have both NEHTA and Standards Australia involved in E-Health Standards setting or should this role be clearly placed in one place of the other?
12. Is it realistic for NEHTA to continue to work on a National Shared EHR when the financial, technical and human aspects of such a project remain so uncertain and problematic?
13. Why is it that NEHTA has not addressed the issues around clinical software quality and certification despite significant clinical and industry concern that guidance is important and needs careful consideration?
14. Does NEHTA have adequate clinical input given its technical importance to the health system?
It seems to me that unless most of these questions can be confidently answered in the affirmative by the Minister then a serious strategic review is virtually mandatory.
The more astute reader may notice that the emphasis in the list above is on strategic rather than technical issues. This actually offers the Minister another approach. He could formally re-constitute AHIC and provide it with a strategically trained and aware E-Health secretariat and have NEHTA then change its role to a technical delivery arm for the AHIC strategy. This would be a very, smart choice. To leave things the way they are would not be.
David.
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