Are You Tired of Being Treated Like a Mushroom – Kept in the Dark and Fed Manure?

This posting will be short and to the point. I was wondering, over the weekend, how many others in the e-Health community feel that all the confidentiality and secrecy surrounding e-Health planning and progress has got a little out of hand. I suspect it may be part of the present electoral cycle but recently I have been seeing two main things happening.

First we have seen all sorts of documents from NEHTA which even by their own admission were just a preview rather than something that could actually be implemented for testing etc. Among the documents I put into this category are:

1. The various technical documents incorporated in the e-Procurement Hub Tender released a month or two ago.

2. The so-called Release 1.0 of the Australian Medicines Terminology (AMT) which was much more like a Release 0.01

3. The Pathology Terminology Reference List v1.0 - Release Note and associated documents

4. The still unreleased document explaining the Selection of HL7 for Australia and what the reasons for the decision were and what the implications for the e-Health Community are. (This document also is one of the secret ones that has been reviewed by consultants – but not been made public for comment by others who might be interested.)

The big question here is why all the haste and why release work that is half finished. Another secret I suppose but I can guess. Maybe a performance review is due?

Second we have news that the Department of Health and Aging (DoHA) and the Australian Health Information Council (AHIC) are working to develop a new e-Health Agenda for the country through a process that is distinctly reminiscent of the work undertaken by the Boston Consulting Group in 2004 and which has led to the present rather unsatisfactory situation in e-Health overall.

Last week a colleague mentioned, in passing, that this directional study was being commissioned and that it was intended that the outcome would be available for consideration by July / August 2007.

Having considered the prospect of such a strategic study, I responded as follows, outlining three points I found concerning about an apparently time, depth and transparency limited approach to the planning.

“First an assumption I have always had regarding any new national strategy is that we should work hard so we don't repeat the mistakes of previous work. These mistakes have certainly included a lack of inclusiveness and a lack of proper consultation with the actual health system and health system providers rather than bureaucrats, peak body representatives and medical politicians as to needs priorities and problems to be addressed. I am not sure what is now asked for is very much the same or not but I think it needs to be raised as a possible risk.

Second, even with a very clever approach, there is a risk of having “lots of time to do it again but not enough time to do it properly”. I also see that as a risk as this is very much a 'last shot in the locker' for 5 years at least. I also fear the political cycle may put time pressures on the project that may make the outcomes less than useful.

My last comment is that, with the way this is all unfolding, the standard operations procedures of DoHA and NEHTA, with almost paranoid confidentiality etc will dominate. This is a worry as it will be a block to getting a real diversity of view and choices to consider. Being 'inside the beltway' can give a very false view of the world.”

I hope my colleague can feed back some of these concerns to the powers that be!

I have no idea how all this will work out ultimately. Given that AHIC has already met twice and there is no public outcome one cannot be all that optimistic. When checked today the AHIC URL was still inactive and I discovered we have a new peak Health Information Management Committee – called the National Health Information Management Principle Committee . There are only two references on the web to this committee and its membership seems pretty obscure. Their functions etc can be found at the following non-DoHA site. More secrecy and very odd I must say!

http://www.e-health.standards.org.au/cat.asp?catid=11

It is amusing that the page lists all the key standing committees but does not mention AHIC!

I really despair of all this – but must continue to hope I guess.

David.