The Medical Software Industry Association (MSIA) is convening a MSIA Round Table Conference on Tuesday – 22nd May, 2007 in Sydney at the Stamford Plaza Sydney Airport Hotel. Tomorrow, if you are reading this on the day it is being posted!
According to the Pre-Meeting Publicity:
“This is a key opportunity for Federal and State Health agencies, clinicians, academics, standards bodies, and health information professionals to exchange views with the nation’s leading providers of clinical software and health communications systems solutions.
With the increase in government Health Information Management initiatives such as Health On-line, The Medical Software Industry Association (MSIA) has become increasingly active in representing the interests of all healthcare software providers and has negotiated a range of important changes.
This MSIA led Round Table Conference will reflect the MSIA's current standing on these relationships and develop strategies to move towards formalising these relationships with industry organisations and government groups. This is a major opportunity for various bodies to express their concerns and aspirations to a wide audience to create a better understanding of major issues affecting the health sector and the impact upon the industry.
Presentation and discussion forums will include:
1. Communicating with the Software Industry – what has worked?
- Commonwealth e-health Agencies and Initiative,
- PBS on-line,
- Pharmbiz,
- DoHA,
- MBF
- nehta Communication Strategies
2. Interoperability and Messaging – Why is it so Hard?
- What Standards should be used?
- Accreditation
- Making e-Communication more like the Telephone Network
3. nehta – what has been achieved?
- SNOMED CT – Update & Licensing
- Medications Terminology
- Building Blocks and Communication
4. E-Claiming
- HIC on-line – What next?
- Is x400 dead?
- Who is making money?
- The banks and e-Claiming
5. The Health IT ‘Action Agenda’
- What is it and what is the potential?
- What I need to know about it?
- How will it help me and my business?
- Current state of play and progress – DoHA presentation
6. The Way Forward and Conclusion”
This sounds like a very useful meeting and it seemed a good opportunity to prepare some thoughts on the question of NEHTA – what has been achieved and to try and form a view as to whether we are headed in the right direction. It is a pity that NEHTA – for their own reasons as I am informed – has chosen not to attend.
I think the answer to the question of what NEHTA has achieved is that "It is too early to tell yet” as the probably apocryphal story suggests was said by the great Chinese revolutionary Chou En-lai when asked for his for his evaluation of the French Revolution.
This said there are two things that can also be said. First , what NEHTA is attempting is no doubt a major complex challenge and second that so far, from the point of view of an external observer, they seem to be going about their brief very incompetently. From where I sit the risk of overall failure looks worryingly high.
What have they and are they doing wrong?
The key things I see as mistakes are:
1. The failure to develop an operational Strategic Plan, Business Case and Implementation Plan to facilitated the delivery of the outcomes sought by Health Ministers in August 2004 when NEHTA was authorized (Based on the Boston Consulting Group work of the same year).
2. The decision to corporatise the NEHTA entity which has removed NEHTA from effective public scrutiny and review and has disengaged the body from many of its public sector clients.
3. The ongoing lack of quality in many of the NEHTA documentary deliverables. Other than the document relating to the adoption of HL7 there have – in the last year – been a series of either useless or incomplete or excessively impractical documents produced with have added minimum value to the Australian E-Health domain. ( A secondary problem is the ‘ex cathedra’ approach to document release).
4. The continuing lack of transparency regarding NEHTA internal decision making with commercial-in-confidence and secrecy being made an art form quite unnecessarily. Given the public policy and standards role NEHTA is meant to play there should be totally open policy development processes and all strategic advice received by NEHTA should be made public for comment and feedback. Equally the NEHTA Board should publish relevant and adequately detailed minutes of the policy aspects of their meetings.
5. The failure to seek proper engagement with the Medical Software Industry.
6. The failure to ensure the boundaries between the roles of DoHA, the Australian Health Information Council, the States and Standards Australia’s IT-14 Committee were well defined and able to be understood so roles and responsibilities were clear.
7. The tokenistic way much of the stakeholder consultation has been undertaken and the almost Joh like “don’t you worry about that” style of management. The privacy consultations undertaken so far are examples of listening at its worst.
8. The obvious “tail wagging the dog” mode of operation seen in the way the NEHTA Executive and the NEHTA Board interact. Given the public sector backgrounds of the Board members if they actually understood what was at stake and enough of what was happening internally within NEHTA to manage it actively I am sure it would be a different, more open, more consultative and much more useful organisation.
9. The failure of the NEHTA Board and Management to recognise there are urgent issues which need to be addressed at both State and Commonwealth levels. The time frames NEHTA is working to are excessively relaxed – especially given the level of resourcing and staff available.
10. The sectional focus – on Public State Hospital Issues and Commonwealth Issues with minimal focus on either the private hospital or private practitioner needs. The lack of a holistic Health System Wide vision and approach is a key failing.
11. The delays that are now becoming obvious in a range of the work program components. The worst apparent examples are in the Benefits Realization , Shared EHR and Medicine Terminology areas.
To date the only successes I can see are the acquisition of the national license for SNOMED CT and the decision to adopt HL7 as a messaging and possibly EHR content Standard. Not much really for the $20+ million NEHTA has cost to date – excluding the money being spent on the UHI projects. Progress on the needed extensions to SNOMED CT before it is useful has been slow and seemingly badly managed if the delays in delivery are anything to go by.
The bottom line is that what NEHTA is trying to do is very badly needed, but the way they are going about it is deeply flawed in my view and the direction needs serious modification.
One can only hope the planned review will get them back on a sensible path.
David.
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