This is probably the most important blog entry I will ever write – as what is decided at the Council of Australian Government (COAG) Meeting on Saturday will decide if we will ever see the full value that e-Health can offer delivered to the Australian public and, incidentally if I will bother writing this blog anymore.
Can I say the reporting over the last few days gives me great concern that there is about to be an awful mistake made.
From yesterdays Australian Financial Review we have the following:
COAG set to give e-health shot in the arm
Wednesday, 26 November 2008 | Ben Woodhead
State and federal government leaders are slated to assess plans for the national introduction of potentially life-saving electronic health records when the Council of Australian Governments meets in Canberra this weekend.
Proponents of the business case -finalised by the National E-Health Transition Authority (NEHTA) in September-are waiting for COAG members to sign off on the plan, which would help implement an individual electronic health record (IEHR) for every Australian resident.
IEHRs are expected to cut the rate of medical error and improve efficiency in the health system by making patient information such as medications and allergies available online to authorised clinicians.
Supporters of the technology had hoped the business case would receive approval at October's COAG meeting, but the discussion slipped off the agenda in the face of the spreading global financial crisis
It is understood the business case is on the agenda for this weekend's meeting. But sources cautioned the number of issues up for discussion meant the planned review could again be bumped.
Nevertheless, a spokeswoman for NEHTA said the organisation was hopeful state and federal leaders would consider the business case.
More here:
What concerns me it the focus on the mythical and poorly defined IEHR and the desire of some (undefined and clearly non-expert individuals) to develop and implement such a system – with the associated reduction on the emphasis on solving the real problems we have at present.
COAG and the Government have had the final version of the Deloittes National E-Health Strategy for month or two. This document is a pragmatic, well thought out, deliberately incremental approach to the development of e-Health in Australia.
It suggests we invest in getting basic infrastructure, secure communications and terminology right (as NEHTA is trying to do at present) while we commence work with both private and public sectors to implement, develop and certify the appropriate applications for each of the sectors of the Health System (Hospitals, GPs and Specialists, Pharmacists, Allied Health and so on). It is at the local ward and clinical desktop where the majority of benefits in terms of quality and safety can be achieved!
The release of the Garling Enquiry today (27 November, 2008) makes the point forcefully regarding the need for operational systems, with him commenting over pages on the inadequate capacity and utility of the information systems in use in NSW Public Hospitals and the negative impact this is having. Mr Garling does not want a slow pace of progress either – he wants full implementation of all relevant applications completed in all hospitals within 4 years. (See pp50-51 of the Executive Summary and Recommendations document)
See:
http://www.lawlink.nsw.gov.au/acsinquiry
There could hardly be more compelling evidence that we need to get the local information technology properly deployed and utilised before we embark on mega and privacy conflicted shared electronic records. Walking before running has always been a sensible approach.
It also suggests we focus on messaging so we can share the information contained in referrals, results, discharge summaries, specialist letters etc and so we can also develop a national e-prescribing environment that goes beyond ‘prescription printing’.
Once this is all working it is then suggested we move progressively to formal health information networking (starting locally and gradually scaling in size) and eventually, maybe, develop shared repositories of crucial clinical information for access where needed and when the public is fully comfortable with the risk benefit profile of such initiatives.
NEHTA on the other hand – desperate to survive after its present funds run out in June 2009 – is pushing that it be allowed to continue its present work – a good idea if better managed – and to undertake this huge national IEHR project – where all the evidence from around the world is that such huge projects inevitably fail unless led and instigated by clinicians (and the public) not technologists – of which NEHTA and Government has very few!
Deloittes also fully addresses the issues of governance of e-Health and ensuring we have appropriate balanced Health Sector input into e-Health with the clinical driving the technical and not the other way around as it has been to date.
If what comes out of COAG is the funds to implement the Deloittes approach over the next few years I will be a happy person. If we see approval for the nebulous IEHR and NEHTA retaining a lead role (with its cultural problems and technological focus) I am out of here and will find something that has a higher chance of success to focus on.
It is my view that this is a significant test of the competence of the Federal Government and Health Minister that the flawed vague and poorly thought HealthConnect Mark II (IEHR) is seen for what it is – a very bad idea.
Of course the option of no new investment in these difficult times also exists. If this happens we will know for sure we have a totally clueless, or worse impotent, administration of the Health Sector.
We will know next week I guess just where we are and whether hope and common sense can prevail.
David.
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